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Intro -- Title Page -- Copyright -- Dedication -- Brief Contents -- Detailed Contents -- Preface -- Part I Introduction -- Chapter 1. History of Health Insurance in the United States -- Prehistory: Workers' Compensation and Sickness Funds -- Early Growth of Health Insurance: The 1940s and 1950s -- The 1960s and 1970s -- The 1980s, 1990s, 2000s, and 2010s: Managed Care and Selective Contracting -- The Legislative History of the Affordable Care Act -- Summary -- Discussion Questions -- For the Interested Reader -- References -- Chapter 2. The Affordable Care Act -- The Uninsured -- The Individual Mandate -- Qualifying Coverage -- Benefit Tiers -- Penalties -- Subsidies -- Cost-Sharing Subsidies -- Allowable Underwriting -- Exchanges: The Healthcare Marketplaces -- Exchange Enrollment -- Employer Mandate -- Medicaid Expansion -- Low-Income People in States That Do Not Expand -- Affordable Care Act Spending and Revenue Projections -- Summary -- Discussion Questions -- For the Interested Reader -- References -- Chapter 3. A Summary of Insurance Coverage -- The Extent of Coverage -- Employer-Sponsored Health Insurance -- Directly Purchased Coverage -- Medicare -- Medicaid and the Children's Health Insurance Program -- Military Coverage -- Coverage by Citizenship -- Health Insurance and the Great Recession of 2007-2009 -- Summary -- Discussion Questions -- For the Interested Reader -- References -- Chapter 4. The Demand for Health Insurance -- The Theory of Insurance -- Hypothesis I: The Degree of Risk Aversion -- Hypothesis II: The Size of the Potential Loss -- Hypothesis III: The Probability of Loss -- Hypothesis IV: The Wealth Effect -- Taxes and Employer-Sponsored Health Insurance -- Summary -- Discussion Questions -- For the Interested Reader -- References -- Part II Issues of Adverse Selection -- Chapter 5. Adverse Selection.

Intro -- Brief Contents -- Detailed Contents -- Preface -- Chapter 1: History of Health Insurance in the United States -- Chapter 2: A Summary of Insurance Coverage -- Chapter 3: The Patient Protection and Affordable Care Act -- Chapter 4: The Demand for Health Insurance -- Chapter 5: Adverse Selection -- Chapter 6: Underwriting and Rate Making -- Chapter 7: Risk Adjustment -- Chapter 8: Moral Hazard and Prices -- Chapter 9: Utilization Management -- Chapter 10: Selective Contracting -- Chapter 11: Managed Care Backlash, Provider Consolidation, and Monopsony Power -- Chapter 12: Insurance Market Structure, Conduct, and Performance -- Chapter 13: Premium Sensitivity for Health Insurance -- Chapter 14: Compensating Differentials -- Chapter 15: Taxes and Employer-Sponsored Health Insurance -- Chapter 16: Employers as Agents -- Chapter 17: Health Savings Accounts and Consumer-Directed Health Plans -- Chapter 18: The Small-Group Market -- Chapter 19: The Individual Insurance Market -- Chapter 20: Health Insurance Regulation -- Chapter 21: High-Risk Pools -- Chapter 22: Health Insurance Exchanges -- Chapter 23: An Overview of Medicare -- Chapter 24: Retiree Coverage -- Chapter 25: Medicaid, Crowd-Out, and Long-Term Care Insurance -- Epilogue -- References -- Name Index -- Subject Index -- About the Author.

"Health insurance is the machinery that makes the US health system run. But what's going on under the hood? Health Insurance, Third Edition, helps students with the nuts and bolts. Bridging the gap between introductory economics courses and the field of healthcare administration, the book applies economic theory to the real world to explain why the health insurance market functions the way it does. Author Michael Morrisey, in a straightforward style, clearly explains such difficult concepts as adverse selection, moral hazard, managed care, and employer-sponsored health insurance. The book is distinguished by its in-depth discussion of research in health economics, both cutting edge and classic. It clarifies additional concepts like risk adjustment, demand, health savings accounts, selective contracting, the diversity of health insurance markets, and the functioning of Medicare and Medicaid. This third edition has been substantially revised to reflect the rapid evolution of the health field. Throughout, data used are the most recent available. Though health insurance has been a major player in the American healthcare system for decades, it's hardly static. This new edition of Health Insurance keeps pace with the changes while also keeping up on the basics"--

This article reviews the empirical literature on the effects of damages caps and concludes that the better-designed studies show that damages caps reduce liability insurance premiums. The effects of damages caps on defensive medicine, physicians' location decisions, and the cost of health care to consumers are less clear. The only study of whether consumers benefit from lower health insurance premiums as a result of damages caps found no impact. Some state courts have based decisions declaring damages caps legislation unconstitutional on the lack of evidence of their effectiveness, thereby ignoring the findings of conflicting research studies or discounting their relevance. Although courts should be cautious in rejecting empirical evidence that caps are effective, legislators should consider whether they benefit consumers enough to justify limiting tort recoveries for those most seriously injured by malpractice.

Physician-organization integration (POI) has emerged as a key issue for hospitals and health systems seeking to improve the quality and cost-effectiveness of care. Although competition and managed care are often cited as primary market drivers of the adoption of POI strategies, prior research has shown only weak associations between these market attributes and POI. This article argues that the role of key organizational decision makers has not been adequately accounted for in explaining strategic change. The study examines the role of hospital CEO perceptions of competition in predicting the adoption of five different approaches to POI. CEO perceptions of general market competition are explained by a combination of market and organizational attributes. Furthermore, when controlling for objective characteristics of the environment and organization, CEO perceptions of competition have consistent, statistically significant associations with four of five measures of POI examined.

Specialty hospitals, particularly those specializing in surgery and owned by physicians, have generated a relatively high degree of policy attention over the past several years. The main focus of policy debates has been in two areas: the extent to which specialty hospitals might compete unfairly with incumbent general hospitals and the extent to which physician ownership might be associated with higher usage. Largely absent from the debates, however, has been a discussion of the basic economic model of specialty hospitals. This article reviews existing literature, reports, and findings from site visits to explore the economic rationale for specialty hospitals. The discussion focuses on six factors associated with specialization: consumer demand, procedural operating margins, clinical efficiencies, procedural economies of scale, economies (and diseconomies) of scope, and competencies and learning. A better understanding of the economics of specialization will help policy makers evaluate the full spectrum of advantages and disadvantages of specialty hospitals.