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Journal Article
Do Other Countries Have a Better Mix of Generalists and Specialists?
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J Health Polit Policy Law (2018) 43 (5): 853–872.
Published: 01 October 2018
... other countries may have had more generalists that fit the OECD definition, many countries have seen a relative decline in the share of generalists that is slowly reshaping the generalist-specialty balance elsewhere. These two factors, along with changing international benchmarks against which...
Journal Article
Improving the Design of Competitive Bidding in Medicare Advantage
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J Health Polit Policy Law (2007) 32 (2): 317–347.
Published: 01 April 2007
... government-run auctions. In particular, CMS can benefit by adjusting its system of competitive bids in four ways: credibly committing to regulations governing bidding; limiting the scope for collusion, entry deterrence, and predatory behavior among bidders; adjusting how benchmark reimbursement rates are set...
Journal Article
Relative Affordability of Health Insurance Premiums Under CHIP Expansion Programs and the ACA
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J Health Polit Policy Law (2011) 36 (5): 859–877.
Published: 01 October 2011
... describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states...
Journal Article
Racial Disparities in Access to Long-Term Care: The Illusive Pursuit of Equity
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J Health Polit Policy Law (2008) 33 (5): 861–881.
Published: 01 October 2008
... persists. Parity in use is an illusive benchmark for measuring progress in assuring equity in treatment. Duke University Press 2008 Agency for Healthcare Research and Quality. 2006. National Healthcare Disparities Report, 2005. January. www.ahrq.gov/qual/nhdr05/nhdr05.htm . Angelelli, J., V...
Journal Article
J Health Polit Policy Law (2014) 39 (2): 441–465.
Published: 01 April 2014
.... The bulletin announced HHS's intention of allowing each state to define essential benefits for itself by choosing a “benchmark” plan modeled on existing plans in the state. The benefits included in that benchmark plan (subject to some adjustments) would be considered essential within the state. On both...
Journal Article
Legislative and Regulatory Options for Improving Medicare Advantage
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J Health Polit Policy Law (2023) 48 (6): 919–950.
Published: 01 December 2023
...), enacted in 2003, introduced a new payment system that established county-level benchmarks and plan bids with the goal to encourage more plan participation and greater enrollment by passing on rebates to plans that bid below their benchmarks. Although the MMA was successful at encouraging plan...
Journal Article
A Decade of ACOs in Medicare: Have They Delivered on Their Promise?
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J Health Polit Policy Law (2023) 48 (1): 63–92.
Published: 01 February 2023
... elements of programs implemented by CMS, this has not been the case for ACOs. Instead, Medicaid and commercial payer contracts have a variety of forms and differ on any number of key dimensions, including financial benchmarking, quality measurement and payment, underlying financial reimbursement models...
FIGURES
Journal Article
J Health Polit Policy Law 11825354.
Published: 28 February 2025
... for overall spending and quality of care for patients attributed to them in exchange for the opportunity to earn bonuses if they meet certain preset spending benchmarks and quality metrics. Both approaches embrace value-based payment and have become the focus of payment reforms in Medicare over the past...
Journal Article
Variation Matters: Epidemiological Surveillance in Europe
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J Health Polit Policy Law (2012) 37 (6): 955–965.
Published: 01 December 2012
... Centre May Have an Important Coordinating Role.” BMJ 323 , no. 7317 : 818 – 19 . doi:10.1136/bmj.323.7317.818 . Reintjes Ralf . 2007 . “Benchmarking National Surveillance Systems: A New Tool for the Comparison of Communicable Disease Surveillance and Control in Europe.” European...
Journal Article
The Affordable Care Act's Enduring Resilience
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J Health Polit Policy Law (2020) 45 (4): 609–616.
Published: 01 August 2020
... market generally going into 2017. The average benchmark premium increased by 20% nationally for 2017 (KFF 2019b ), and the share of Marketplace enrollees with a choice of only one insurer increased from 2% in 2016 to 21% in 2017 (Fehr, Kamal, and Cox 2019). The ACA seemed on the ropes...
Journal Article
Sources of Success in California's Individual Marketplace under the Affordable Care Act
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J Health Polit Policy Law (2019) 44 (4): 679–706.
Published: 01 August 2019
... ; Covered California 2016a ). Looking only at the benchmark plan's premium, Covered California had a 4% increase after the first year, a 0% increase after the second year, a 9.3% increase after the third year, and a 26.1% increase after the fourth year ( table 2 ) (Kaiser Family Foundation 2014–18a ). 2...
FIGURES
Journal Article
The New Jersey Medicaid ACO Demonstration Project: Seeking Opportunities for Better Care and Lower Costs among Complex Low-Income Patients
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J Health Polit Policy Law (2014) 39 (6): 1185–1211.
Published: 01 December 2014
... to estimate the extent to which ACOs might reduce hospital costs by improving management of high users of care. First, we apply a “benchmark” method in which potentially achievable savings are calculated as the amount by which total hospital costs of high-using patients would be reduced if the respective area...
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Includes: Supplementary data
Journal Article
The Future of State All-Payer Claims Databases
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J Health Polit Policy Law (2023) 48 (1): 93–115.
Published: 01 February 2023
... adherence to state-established growth benchmarks for health care spending, identifying low-value health care spending as targets for cost containment, enhancing regulatory functions including antitrust measures, and assessing implementation of new mandated health care benefits. Each will be discussed...
Journal Article
International Reference Pricing in the Context of US Drug Policy
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J Health Polit Policy Law (2022) 47 (6): 779–796.
Published: 01 December 2022
... in the context of alternative approaches. IRP refers to a payer's use of prices in other countries to establish benchmarks for negotiation or to set price caps on prescription drugs for their own domestic use. In practice, the IRP is used by a nation's regulatory authority in charge of setting...
Journal Article
J Health Polit Policy Law 11830274.
Published: 28 February 2025
... analysts would prefer to, in their words, level the playing field. That is, they want to shrink the overpayments to MA plans so plans have fewer resources with which to attract beneficiaries. To do so, analysts have proposed replacing MA s risk scoring system, addressing inflated payment benchmarks...
Journal Article
Review of Medicare, Medicaid, and Commercial Quality of Care Measures: Considerations for Assessing Accountable Care Organizations
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J Health Polit Policy Law (2015) 40 (4): 761–796.
Published: 01 August 2015
... thirty-two quality measures over three ACSCs: diabetes mellitus, congestive heart failure (CHF), and coronary artery disease. ■ Overall, all ten PGPD participants were successful in meeting benchmarks for twenty-nine out of thirty-two quality measures. For diabetes, heart failure, and cancer screenings...
FIGURES
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Journal Article
An Economic Perspective on the Affordable Care Act: Expectations and Reality
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J Health Polit Policy Law (2020) 45 (5): 889–904.
Published: 01 October 2020
... trillion Per capita health care spending † $ 8,131 $ 11,172 $ 3,041 Annual spending growth † Total health care 4.0% 4.6% — Medicare 6.8% 6.4% — Medicaid 8.8% 3.0% — Private 3.5% 5.8% Monthly benchmark plan premium * $ 273 (2014) $ 481...
Journal Article
Physician Trust in the News Media and Attitudes toward COVID-19
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J Health Polit Policy Law (2023) 48 (3): 317–350.
Published: 01 June 2023
... or as general practitioners, and they completed the survey. 8 On average, survey respondents took 15 minutes to complete the survey. While our sample of physicians is national in scope, it is technically and necessarily a nonprobability sample. Using population benchmarks from the American Medical...
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Journal Article
J Health Polit Policy Law 11825362.
Published: 28 February 2025
...). The higher payments to Medicare Advantage plans relative to spending in traditional Medicare are due to several factors. In more than half of all U.S. counties, the Medicare Advantage benchmark (the maximum amount the federal government is willing to pay private insurers) is set above spending on traditional...
Journal Article
Beyond Competition: The Normative Implications of Consumer-Driven Health Plans
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J Health Polit Policy Law (2006) 31 (3): 671–685.
Published: 01 June 2006
.... 1985 . Just Health Care . New York: Oxford University Press. ____. 1990 . Insurability and the HIV Epidemic: Ethical Issues in Underwriting. Milbank Quarterly 68 : 497 -526. Daniels, N., J. Bryant, R. A. Castano, O. G. Dantes, K. S. Khan, and S. Pannarunothai. 2000 . Benchmarks of Fairness...
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