Thomas Rice

​This publication offers united and synthesized information currently available only in scattered locations — if at all — to students, researchers, and policymakers. The book provides helpful contexts, so people worldwide can understand various health care systems. By using it as a guide to the mechanics of different health care systems, readers can examine existing systems as frameworks for developing their own. Case examples of countries adopting insurance characteristics from other countries enhance the critical insights offered in the book. If more information about health insurance alternatives can lead to better decisions, this guide can provide an essential service.

Key Features

• Delivers fundamental insights into the different ways that countries organize their health insurance systems
• Presents ten prominent health insurance systems in one book, facilitating comparisons and contrasts, to help draw policy lessons
• Countries included are Australia, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, the United Kingdom, and the United States
• Helps students, researchers, and policymakers searching for innovative designs by providing cases describing what countries have learned from each other

Read the Publication:

• Journal Article: Health Insurance Systems, An International Comparison

​Summary: Research suggests that the Affordable Care Act (ACA) Medicaid expansions improved financial protection for the poor. However, evidence is limited on whether subsidies offered through the ACA Marketplaces, the law’s other major coverage expansion, were associated with reduced financial burden. Using national survey data from the period 2008–2017, authors examined changes in household health care spending among low-income adults eligible for both Marketplace premium subsidies and cost-sharing reductions (139%–250% of the federal poverty level) and middle-income adults eligible only for premium subsidies (251%–400% of the federal poverty level), using high-income adults ineligible for subsidies (greater than 400% of the federal poverty level) as controls. 

Findings: Among low-income adults, Marketplace subsidy implementation was associated with 17% lower out-of-pocket spending and 30% lower probability of catastrophic health expenditures. In contrast, middle-income adults did not experience reduced financial burden by either measure. These findings highlight the successes and limitations of Marketplace subsidies as debate continues over the ACA’s future.

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• Journal Article: The Affordable Care Act’s Insurance Marketplace Subsidies Were Associated with Reduced Financial Burden for US Adults

​The individual health insurance market has grown significantly since the 2014 implementation of the Affordable Care Act’s state-based and federally facilitated Marketplaces. During annual open enrollment periods, Marketplace enrollees can switch plans for the upcoming year. The percentage of re-enrollees in California’s state-based Marketplace, Covered California, who made changes to their coverage steadily increased between the 2014–15 and 2017–18 open enrollment periods. Following the implementation of “silver loading”— in which insurers raised 2018 silver-tier plan premiums to compensate for their loss of federal payments for cost-sharing reductions — the proportion of consumers who moved into gold plans during the 2017–18 open enrollment period dramatically increased, compared to previous years. Among bronze or silver plan enrollees who switched metal tiers during open enrollment, those who could enroll in gold plans that were no more than $49 per month more expensive than their initial bronze or silver plan had a significantly higher probability of switching to gold coverage than those who faced larger premium differences.

Publication Authors:
 

• Petra Rasmussen, MPH
• Thomas Rice, PhD
• Gerald F. Kominski, Ph.D.

​This study aimed to examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs. private. Authors analyzed ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).

• Charleen Hsuan, JD, PhD
• Ninez A. Ponce, PhD, MPP
• Thomas Rice, PhD
• Jack Needleman, PhD, FAAN
• et al