This article explores the challenges inherent in linking data from disparate sources-electronic medical records (EMR) and health insurer claims-and the probable benefits of doing so to evaluate several quality measures associated with diabetes. Using the business associate agreement provision of the Health Insurance Portability and Accountability Act, we were able to link health insurer claims ...

This executive summary of Senator Durenberger's remarks was prepared by Julie Snyder of the University of Texas LBJ School of Public Affairs. The remarks were given in the context of a panel presentation moderated by Senator Durenberger, entitled "Provider and Insurer Perspective."

A health care provider chooses medical service quality and cost-reduction e§ort. Both choices are noncontractible. An insurer observes both quality and cost e§ort, and may credibly disclose them to consumers. In prospective payment, the insurer fully discloses care quality, and sets a prospective payment price. In cost reimbursement, the insurer discloses a value index, a weighted average of qu...

In the Medicare program, increases in cost sharing by a supplemental insurer can exert financial externalities. We study a policy change that raised patient cost sharing for the supplemental insurer for retired public employees in California. We find that physician visits and prescription drug usage have elasticities that are similar to those of the RAND Health Insurance Experiment (HIE). Unlik...

This paper studies the optimal investment problem for an insurer in an incompletemarket.The insurer’s risk process ismodeled by a Lévy process and the insurer is supposed to have the option of investing inmultiple risky assets whose price processes are described by the standard Black-Scholes model. The insurer aims to maximize the expected utility of terminal wealth. After the market is complet...

Numerous firms offer competing ratings of insurer financial condition. Insurance consumers, producers, and others commonly puzzle over which rating is more accurate. A 1994 Government Accounting Office (GAO) report judged the performance of a group of these insurance rating agencies. That report focused on Type I error (i.e., too high a rating on an insurer that defaults) rather than an appropr...

There is a wide cross-country variation in the institutional structure of bank failure resolution, including the role of the deposit insurer. We use quantitative analysis for 57 countries and discussion of specific country cases to illustrate this variation. Using data for over 1,700 banks across 57 countries, we show that banks in countries where the deposit insurer has the responsibility of i...

We measure the impact of increased health insurer competition on negotiated hospital prices using detailed 2004 California claims data. We develop a theoretical bargaining model to motivate our empirical analysis, and use the competitiveness of Kaiser Permanente, a large vertically integrated insurer, in a hospital’s market as a measure of insurer competition. We find that increasing competitio...

We study the continuous-time portfolio optimization problem of an insurer. The wealth of the insurer is given by a classical risk process plus gains from trading in a risky asset, modelled by a geometric Brownian motion. The insurer is not only interested in maximizing the expected utility of wealth but is also concerned about the ruin probability. We thus investigate the problem of optimizing ...

Why do insurers choose to exclude medical providers, and when would this be socially desirable? We examine network design from the perspective of a profit maximizing insurer and a social planner in order to evaluate the effects of narrow networks and restrictions on their use—a form of quality regulation. An insurer may wish to exclude hospitals in order to steer patients to less expensive prov...