E M P L O Y E E B E N E F I T S , C O M P E N S A T I O N
& P E N S I O N L A W
Vol. 5, No. 18: September 24, 2004
_________________________________________________________________
Publisher: LSN Employment, Labor, Compensation & Pension Journals
a division of
Social Science Electronic Publishing, Inc. (SSEP)
and Social Science Research Network (SSRN)
Editor: PAMELA PERUN
Urban Institute
Mailto:pamela@planetnow.com
Copyright: SSEP, Inc. 2004. All rights reserved.
Leading Social Science Research Delivered To Your Desktop
http://www.SSRN.Com/
___________________________________________________________
Topic of This Issue:
Healthcare Issues
___________________________________________________________
SEARCHING THE SSRN ELECTRONIC LIBRARY
To search the entire SSRN Electronic Library by author, title,
JEL code, or full text of the abstracts in our database, please
visit http://papers.ssrn.com/
To browse all abstracts published in this journal, please visit
http://www.ssrn.com/link/benefits-compensation-pension-law.html
REDISTRIBUTION
Individual and professional subscriptions to the journal are for
single users. It is a violation of copyright to redistribute
this document electronically or otherwise without the explicit
permission of Social Science Electronic Publishing, Inc.
Site licenses for organizations are available by contacting
Mailto:Site@SSRN.Com
SIGN OFF
SUBSCRIPTION MANAGEMENT
You can change your journal subscriptions by going to the SSRN
User HeadQuarters at the following link: http://hq.ssrn.com
Please enter the email address where you received this email in
the "Your Email Address" field and click "Submit". Click on your
name on the next screen, and your User ID and Password will be
emailed to you. Once you have received your login information and
successfully logged in, you will be able to change your journal
selections. If you have questions or problems with this process,
please email UserSupport@SSRN.com or call 877-SSRNHelp (toll free
877.777.6435).
ALIGNMENT
If this document is misaligned, please set type face to a
non-proportional font such as Courier 10.
PAPER DOWNLOADS
If you need assistance downloading papers from our web site,
please contact Mailto:Support@SSRN.Com
T A B L E of C O N T E N T S
_________________________________________________________________
NEW and FORTHCOMING ARTICLES
"The Supreme Court Limits Lawsuits Against Managed Care
Organizations"
Health Affairs, Web Exclusive, August 2004
TIMOTHY STOLTZFUS JOST
Washington and Lee University
School of Law
"Has There Been a Shift to Small Firms? The Impact of Firm Size
on Employment-Based Health Benefits"
EBRI Notes, Vol. 25, No. 8, August 2004
PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
"Employee Choice of Consumer Driven Health Insurance in a
Multi-Plan, Multi-Product Setting"
Health Services Research, Vol. 39, No. 4, Part II, pp.
1091-1111, August 2004
STEPHEN T. PARENTE
University of Minnesota - Twin Cities
Department of Health Care Management
National Bureau of Economic Research (NBER)
ROGER FELDMAN
University of Minnesota - Twin Cities
Department of Economics
JON CHRISTIANSON
University of Minnesota - Twin Cities
"Evaluation of the Effect of a Consumer Driven Health Plan on
Medical Care Expenditures and Utilization"
Health Services Research, Vol. 39, No. 4, Part II, pp.
1189-1209, August 2004
STEPHEN T. PARENTE
University of Minnesota - Twin Cities
Department of Health Care Management
National Bureau of Economic Research (NBER)
WORKING PAPERS
"When Should Medicare Coverage Begin?"
RICHARD W. JOHNSON
Urban Institute - Income and Benefits Policy Center
National Academy of Social Insurance (NASI)
"The Effect of Health Changes and Long-Term Health on the Work
Activity of Older Canadians"
DOREEN AU
McMaster University
THOMAS F. CROSSLEY
McMaster University
Department of Economics
Institute for the Study of Labor (IZA)
MARTIN SCHELLHORN
Institute for the Study of Labor (IZA)
"How Much Might Universal Health Insurance Reduce Socioeconomic
Disparities in Health? A Comparison of the US and Canada"
SANDRA L. DECKER
International Longevity Center
National Bureau of Economic Research (NBER)
DAHLIA REMLER
City University of New York - Baruch College -
School of Public Affairs
National Bureau of Economic Research (NBER)
S S R N I N F O R M A T I O N
_________________________________________________________________
* Partners in Publishing
* Administrative Information
- Missing issues & change of address
- Solicitation of abstracts
* Directors
* Subscription to SSRN Journals
_________________________________________________________________
ACQUIRING PAPERS
Download papers directly from the included web address or contact
the author or other contact person directly. Provide an address
to which the author or other contact person can send a paper
copy and mention that you saw the abstract in SSRN. Some of
SSRN's Partners in Publishing require a subscription or charge a
fee for electronic downloads.
EDITORIAL POLICIES
To provide the broadest coverage of research in Employee
Benefits, Compensation & Pension Law we do not referee working
papers. We accept abstracts of working papers in Employee
Benefits, Compensation & Pension Law whose topics suit the
coverage of the journal and which are part of the worldwide
scholarly discourse.
N E W and F O R T H C O M I N G Articles
_________________________________________________________________
"The Supreme Court Limits Lawsuits Against Managed Care
Organizations"
Health Affairs, Web Exclusive, August 2004
BY: TIMOTHY STOLTZFUS JOST
Washington and Lee University
School of Law
Paper ID: Washington & Lee Legal Studies Paper No. 04-14
Contact: TIMOTHY STOLTZFUS JOST
Email: Mailto:JOSTT@WLU.EDU
Postal: Washington and Lee University
School of Law
Lexington, VA 24450 UNITED STATES
Phone: 540-458-8510
Fax: 540-458-8488
ABSTRACT:
In Aetna Health Inc. v. Davila, the United States Supreme Court
revisited the question of whether the Employee Retirement Income
Security Act (ERISA) precludes state lawsuits against ERISA
plans. The Court held that ERISA preempts damage actions brought
against managed care organizations under the Texas Health Care
Liability Act because ERISA itself provides the exclusive remedy
for challenging ERISA plans' coverage decisions. The Court
suggested, however, that health plans might be liable for
treatment decisions made by employed physicians. It also
volleyed back to Congress the question of whether ERISA
beneficiaries should have any remedy for damages caused by
coverage decisions.
______________________________
"Has There Been a Shift to Small Firms? The Impact of Firm Size
on Employment-Based Health Benefits"
EBRI Notes, Vol. 25, No. 8, August 2004
BY: PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=578161
Contact: PAUL FRONSTIN
Email: Mailto:FRONSTIN@EBRI.ORG
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Phone: 202-775-6352
Fax: 202-775-6312
ABSTRACT:
This paper examines changes in the distribution of workers among
different size firms and the resulting impact on
employment-based health benefits. Small firms account for much
of the new job growth in the United States. However, the
percentage of workers in firms with fewer than 500 employees has
declined slightly between the 1980s and today. In addition,
workers in small firms are much less likely to have health
benefits than workers in large firms. There has been a decline
in the probability that a worker had employment-based health
benefits between 1987 and 2002 across nearly all firm sizes.
Only in firms with fewer than 25 employees did the percentage of
workers with employment-based health benefits from their own
employer not decline, increasing slightly from 30 percent to
30.8 percent over the period.
The PDF for the above title, published in the August 2004
issue of EBRI Notes, also contains the fulltext of another
August 2004 EBRI Notes article abstracted on SSRN: "IRA and
Keogh Assets and Contributions."
JEL Classification: I11, J21, J33
______________________________
"Employee Choice of Consumer Driven Health Insurance in a
Multi-Plan, Multi-Product Setting"
Health Services Research, Vol. 39, No. 4, Part II, pp.
1091-1111, August 2004
BY: STEPHEN T. PARENTE
University of Minnesota - Twin Cities
Department of Health Care Management
National Bureau of Economic Research (NBER)
ROGER FELDMAN
University of Minnesota - Twin Cities
Department of Economics
JON CHRISTIANSON
University of Minnesota - Twin Cities
Contact: STEPHEN T. PARENTE
Email: Mailto:sparente@csom.umn.edu
Postal: University of Minnesota - Twin Cities
Department of Health Care Management
Room 3-149
321 19th Avenue South
Minneapolis, MN 55455 UNITED STATES
Co-Auth: ROGER FELDMAN
Email: Mailto:feldm002@umn.edu
Postal: University of Minnesota - Twin Cities
Department of Economics
15-205 Phillips-Wangensteen
271 19th Avenue South
Minneapolis, MN 55455 UNITED STATES
Co-Auth: JON CHRISTIANSON
Email: Mailto:chris001@umn.edu
Postal: University of Minnesota - Twin Cities
Healthcare Management, Inst For Hlth Services Rese
19th Avenue South
Minneapolis, MN 55455 UNITED STATES
ABSTRACT:
Objective: To determine who chooses a Consumer Driven Health
Plan (CDHP) in a multi-plan, multi-product setting, and,
specifically, whether the CDHP attracts the sicker employees in
a company's risk pool.
Study Design: We estimated a health plan choice equation for
employees of the University of Minnesota, who had a choice in
2002 of a CDHP and three other health plans - a traditional HMO,
a preferred provider organization (PPO), and a tiered network
product based on care systems. Data from an employee survey were
matched to information from the university's payroll system.
Principal Findings: Chronic illness of the employee or family
members had no effect on choice of the CDHP, but such employees
tended to choose the PPO. The employee's age was not related to
CDHP choice. Higher-income employees chose the CDHP, as well as
those who preferred health plans with a national provider panel
that includes their physician in the panel. Employees tended to
choose plans with lower out-of-pocket premiums, and
surprisingly, employees with a chronic health condition
themselves or in their family were more price-sensitive.
Conclusions: This study provides the first evidence on who
chooses a CDHP in a multi-plan, multi-product setting. The CDHP
was not chosen disproportionately by the young and healthy, but
it did attract the wealthy and those who found the availability
of providers more appealing. Low out-of-pocket premiums are
important features of health plans and in this setting, low
premiums appeal to those who are less healthy.
JEL Classification: I1, D12, D81
______________________________
"Evaluation of the Effect of a Consumer Driven Health Plan on
Medical Care Expenditures and Utilization"
Health Services Research, Vol. 39, No. 4, Part II, pp.
1189-1209, August 2004
BY: STEPHEN T. PARENTE
University of Minnesota - Twin Cities
Department of Health Care Management
National Bureau of Economic Research (NBER)
Contact: STEPHEN T. PARENTE
Email: Mailto:sparente@csom.umn.edu
Postal: University of Minnesota - Twin Cities
Department of Health Care Management
Room 3-149
321 19th Avenue South
Minneapolis, MN 55455 UNITED STATES
ABSTRACT:
Objective: To compare medical care costs and utilization in a
consumer directed health plan (CDHP) to other health insurance
plans.
Study Design: We examine claims and employee demographic data
from one large employer that adopted a CDHP in 2001. A
quasi-experimental pre/post design is used to assign employees
to three cohorts: 1) enrolled in an HMO from 2000 to 2002, 2)
enrolled in a PPO from 2000 to 2002, or 3) enrolled in a CDHP in
2001 and 2002, after previously enrolling in either an HMO or
PPO in 2000. Using this approach we estimate a
difference-in-difference regression model for expenditure and
utilization measures to identify the impact of CDHP.
Principal Findings: By 2002, the CDHP cohort experienced lower
total expenditures than the PPO cohort but higher expenditures
than the HMO cohort. Physician visits and pharmaceutical use and
costs were lower in the CDHP cohort compared to the other
groups. Hospital costs and admission rates, for CDHP enrollees,
as well as total physician expenditures, were significantly
higher than for enrollees in the HMO and PPO plans.
Conclusions: An early evaluation of CDHP expenditure and
utilization reveals that the new health plan is a viable
alternative to existing health plan designs. Enrollees in the
CDHP have lower total expenditures than PPO enrollees, but
higher utilization of resource-intensive hospital admissions
after an initially favorable selection.
JEL Classification: I1, D12, C93
______________________________
W O R K I N G P A P E R Abstracts
_________________________________________________________________
"When Should Medicare Coverage Begin?"
BY: RICHARD W. JOHNSON
Urban Institute - Income and Benefits Policy Center
National Academy of Social Insurance (NASI)
Date: December 2003
Contact: RICHARD W. JOHNSON
Email: Mailto:RJOHNSON@UI.URBAN.ORG
Postal: Urban Institute - Income and Benefits Policy Center
2100 M Street, NW
Washington, DC 20037 UNITED STATES
Phone: 202-261-5541
Fax: 202-833-4388
ABSTRACT:
Lowering the Medicare eligibility age to 62 would result in near
universal health care coverage among 62 to 64 year olds. People
who purchase individual insurance in the market, as well as the
uninsured, could benefit from Medicare coverage. The change
would reduce employer costs for retiree health benefits and
lower both retiree and employer costs for COBRA continuation
coverage. Lowering the automatic eligibility age to 62 would
increase Medicare spending by about $5.4 billion a year (in 2000
dollars). Net federal spending would be about $5.0 billion
higher, because Medicare would pick up some costs currently paid
by Medicaid. State Medicaid outlays would fall by about $0.3
billion.
______________________________
"The Effect of Health Changes and Long-Term Health on the Work
Activity of Older Canadians"
BY: DOREEN AU
McMaster University
THOMAS F. CROSSLEY
McMaster University
Department of Economics
Institute for the Study of Labor (IZA)
MARTIN SCHELLHORN
Institute for the Study of Labor (IZA)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=586761
Paper ID: IZA Discussion Paper No. 1281
Date: September 2004
Contact: THOMAS F. CROSSLEY
Email: Mailto:crossle@mcmaster.ca
Postal: McMaster University
Department of Economics
Hamilton, Ontario L8S 4M4 CANADA
Phone: 905-525-9140
Fax: 905-521-8232
Co-Auth: DOREEN AU
Email: Mailto:doreenau123@yahoo.com
Postal: McMaster University
1280 Main Street West
Hamilton, Ontario L8S 4M4 CANADA
Co-Auth: MARTIN SCHELLHORN
Email: Mailto:schellhorn@iza.org
Postal: Institute for the Study of Labor (IZA)
P.O. Box 7240
D-53072 Bonn, GERMANY
ABSTRACT:
Using longitudinal data from the Canadian National Population
Health Survey (NPHS), we study the relationship between health
and employment among older Canadians. We focus on two issues:
(1) the possible endogeneity of self-reported health,
particularly justification bias, and (2) the relative importance
of health changes and long-term health in the decision to work.
The NPHS contains the HUI3, an objective health index which has
been gaining popularity in empirical work. We contrast estimates
of the impact of health on employment using self-assessed
health, the HUI3, and a purged health measure similar to that
employed by Bound et al. (1999) and Disney et al. (2003). A
direct test suggests that self-assessed health suffers from
justification bias. However, the HUI3 provides estimates that
are similar to the purged health measure. We also corroborate
recent U.S. and U.K. findings that changes in health are
important in the work decision.
JEL Classification: I12, J26
______________________________
"How Much Might Universal Health Insurance Reduce Socioeconomic
Disparities in Health? A Comparison of the US and Canada"
BY: SANDRA L. DECKER
International Longevity Center
National Bureau of Economic Research (NBER)
DAHLIA REMLER
City University of New York - Baruch College -
School of Public Affairs
National Bureau of Economic Research (NBER)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=583428
Paper ID: NBER Working Paper No. W10715
Date: August 2004
Contact: SANDRA L. DECKER
Email: Mailto:sandrad@ilcusa.org
Postal: International Longevity Center
60 East 86th Street
New York, NY 10028 UNITED STATES
Co-Auth: DAHLIA REMLER
Email: Mailto:dahlia_remler@baruch.cuny.edu
Postal: City University of New York - Baruch College - School of
Public Affairs
New York, NY 10021 UNITED STATES
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
A strong association between lower socioeconomic status (SES)
and worse health - the SES-health gradient - has been documented
in many countries, but little work has compared the size of the
gradient across countries. We compare the size of the income
gradient in self-reported health in the US and Canada. We find
that being below median income raises the likelihood that a
middle aged person is in poor or fair health by about 15
percentage points in the US, compared to less than 8 percentage
points in Canada. We also find that the 7 percentage point
gradient difference between the two countries is reduced by
about 4 percentage points after age 65, the age at which the
virtually all US citizens receive basic health insurance through
Medicare. Income disparities in the probability that an
individual lacks a usual source of care are also significantly
larger in the US than in Canada before the age of 65, but about
the same after 65. Our results are therefore consistent with the
availability of universal health insurance in the US, or at
least some other difference that occurs around the age of 65 in
one country but not the other, narrowing SES differences in
health between the US and Canada.
JEL Classification: I1