Do health insurance and hospital market concentration influence hospital patients’ experience of care?
Health Services Research
Caroline Hanson PhD, Bradley Herring PhD, Erin Trish PhD
To examine the effects of insurance and hospital market concentration on hospital patients’ experience of care, as hospitals may compete on quality for favorable insurance contracts.
Geographic variation in the delivery of high-value inpatient care
John Romley, Erin Trish, Dana Goldman, Melinda Beeuwkes Buntin, Yulei He, Paul Ginsburg
To measure value in the delivery of inpatient care and to quantify its variation across U.S. regions.
Growing Number Of Unsubsidized Part D Beneficiaries With Catastrophic Spending Suggests Need For An Out-Of-Pocket Cap
Erin Trish, Jianhui Xu, and Geoffrey Joyce
Medicare Part D has no cap on beneficiaries’ out-of-pocket spending for outpatient prescription drugs, and, unlike Medicare Parts A and B, beneficiaries are prohibited from purchasing supplemental insurance that could provide such a cap. Historically, most beneficiaries whose annual Part D spending reached the catastrophic level were protected from unlimited personal liability by the Low-Income Subsidy (LIS). However, we found that the proportion of beneficiaries whose spending reached that level but did not qualify for the subsidy—and therefore remained liable for coinsurance—increased rapidly, from 18 percent in 2007 to 28 percent in 2015. Moreover, average total per person per year spending grew much more rapidly for those who did not qualify for the LIS than for those who did, primarily because of differences in price and utilization trends for the drugs that represented disproportionately large shares of their spending. We estimated that a cap for all Part D enrollees in 2015 would have raised monthly premiums by only $0.40–$1.31 per member.
Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance
JAMA Internal Medicine
Erin Trish, PhD; Paul Ginsburg, PhD; Laura Gascue, MS; et al
Question: How does physician reimbursement in Medicare Advantage compare with traditional Medicare’s rates and commercial health insurance rates?
Does Limiting Allowable Rating Variation in the Small Group Health Insurance Market Affect Employer Self-Insurance?
Journal of Risk and Insurance
Erin Trish Bradley Herring
The Affordable Care Act (ACA) imposes adjusted community rating in the small group market, which employers can avoid by self‐insuring, raising concerns about adverse selection. We evaluate the impact of limiting allowable rating variation on employer self‐insurance across industries with varied health risk, using cross‐state variation in pre‐ACA rating regulations, the nationally representative 2008–2013 KFF/HRET Employer Health Benefits Survey, and a triple‐difference regression approach. We find that lower risk employers subject to laws limiting allowable premium rating variation have a predicted probability of self‐insurance that is about 18 percentage points higher than otherwise‐similar higher risk employers, suggesting that these selection concerns are warranted.