WorldCat Identities

McGuire, Thomas G. 1950-

Works: 69 works in 258 publications in 1 language and 3,047 library holdings
Genres: Conference papers and proceedings  Academic theses  Patents  Periodicals  Handbooks and manuals 
Roles: Author, Editor, Other
Classifications: RA410, 338.433621
Publication Timeline
Most widely held works by Thomas G McGuire
Handbook of health economics by Mark V Pauly( Book )

28 editions published between 2000 and 2012 in English and held by 742 WorldCat member libraries worldwide

What new theories, evidence, and policies have shaped health economics in the 21st century? Editors Mark Pauly, Thomas McGuire, and Pedro Pita Barros assemble the expertise of leading authorities in this survey of substantive issues. In 16 chapters they cover recent developments in health economics, from medical spending growth to the demand for health care, the markets for pharmaceutical products, the medical workforce, and equity in health and health care. Its global perspective, including an emphasis on low and middle-income countries, will result in the same high citations that made Volume 1 (2000) a foundational text. Presents coherent summaries of major subjects and methodologies, marking important advances and revisions. Serves as a frequently used non-journal reference. Introduces non-economists to the best research in health economics
Financing psychotherapy : costs, effects, and public policy by Thomas G McGuire( Book )

6 editions published in 1981 in English and Undetermined and held by 238 WorldCat member libraries worldwide

Economics and mental health( Book )

2 editions published in 1981 in English and held by 146 WorldCat member libraries worldwide

Measuring adverse selection in managed health care by Richard G Frank( )

17 editions published between 1998 and 1999 in English and held by 139 WorldCat member libraries worldwide

Health plans paid by capitation have an incentive to distort the quality of services they offer to attract profitable and to deter unprofitable enrollees. We characterize plans' rationing as imposing a show that the profit maximizing shadow price depends on the dispersion in health costs, how well individuals forecast their health costs, the correlation between use in different illness categories, and the risk adjustment system used for payment. We further show how these factors can be combined in an empirically implementable index that can be used to identify the services that will be most distorted in competition among managed care plans. A simple welfare measure is developed to quantify the distortion caused by selection incentives. We illustrate the application of our ideas with a Medicaid data set, and conduct policy analyses of risk adjustment and other options for dealing with adverse selection
Parity for mental health and substance abuse care under managed care by Richard G Frank( )

14 editions published between 1998 and 1999 in English and held by 132 WorldCat member libraries worldwide

Background: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services. Aims: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage. Method: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance. Results: We show that since managed care controls and utilization in new ways Parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less with respect to providing a remedy to problems related to adverse selection
Economics and mental health by Richard G Frank( )

16 editions published between 1981 and 1999 in English and held by 130 WorldCat member libraries worldwide

This paper is concerned with the economics of mental health. We argue that mental health economics is like health economics only more so: uncertainty and variation in treatments are greater; the assumption of patient self-interested behavior is more dubious; response to financial incentives such as insurance is exacerbated; the social consequences and external costs of illness are formidable. We elaborate on these statements and consider their implications throughout the chapter. Special characteristics' of mental illness and persons with mental illness are identified and related to observations on institutions paying for and providing mental health services. We show that adverse selection and moral hazard appear to hit mental health markets with special force. We discuss the emergence of new institutions within managed care that address long-standing problems in the sector. Finally, we trace the shifting role of government in this sector of the health economy
Alternative insurance arrangements and the treatment of depression : what are the facts? by Ernst R Berndt( )

15 editions published in 1996 in English and held by 119 WorldCat member libraries worldwide

Using insurance claims data from nine large self-insured employers offering 26 alternative health benefit plans, we examine empirically how the composition and utilization for the treatment of depression vary under alternative organizational forms of insurance (indemnity, preferred provider organization networks or PPOs, and mental health carve-outs), and variations in patient cost-sharing (copayments for psychotherapy and for prescription drugs). Although total outpatient mental health/substance abuse (MHSA) expenditures per treated individual do not vary significantly across insurance forms, the depressed outpatient is more likely to receive anti-depressant drug (ADD) medications in PPOs and carve-outs than under indemnity insurance. Those individuals facing higher copayments for psychotherapy are more likely to receive ADD medications. For those receiving ADD treatment, increases in prescription drug copay tend to increase the share of ADD medication costs accounted for by the newest (and more costly) generation of drugs, the selective serotonin reuptake inhibitors
Cost-offsets of new medications for treatment of schizophrenia by Richard G Frank( )

9 editions published in 2006 in English and held by 89 WorldCat member libraries worldwide

Broad claims are frequently made that new medications will offset all or part of their costs by reducing other areas of Medicaid spending. In this paper we examine the net impact on spending for new drugs used to treat schizophrenia. We extend research in this area by taking a new approach to identification of spending impacts of new drugs. We specify and estimate models of spending on treatment of schizophrenia using 7 years of Florida Medicaid data. The estimates indicate that use of the new drugs result in net spending increases. This may be due to increased adherence to treatment
Mental health treatment and criminal justice outcomes by Richard G Frank( )

7 editions published in 2010 in English and held by 83 WorldCat member libraries worldwide

Are many prisoners in jail or prison because of their mental illness? And if so, is mental health treatment a cost-effective way to reduce crime and lower criminal justice costs? This paper reviews and evaluates the evidence assessing the potential of expansion of mental health services for reducing crime. Mental illness and symptoms of mental illness are highly prevalent among adult and child criminal justice populations. The association between serious mental illness and violence and arrest is particularly strong among individuals who are psychotic and do not adhere to medication. Two empirical studies augment the empirical research base relating mental illness to crime. In a recent community sample of adults, we find higher rates of arrest for those with serious mental illness and with substance abuse. Among youth, even with family fixed effects, antisocial personality scores predict future school problems and arrests. A large body of research tracks mental health and criminal justice outcomes associated with treatments and social policies. Reviews of the cost-effectiveness of treatments for children with behavioral problems, mental health courts, and mandatory outpatient treatment are inconclusive
A primer on the economics of prescription pharmaceutical pricing in health insurance markets by Ernst R Berndt( )

7 editions published in 2011 in English and held by 79 WorldCat member libraries worldwide

The pricing of medical products and services in the U.S. is notoriously complex. In health care, supply prices (those received by the manufacturer) are distinct from demand prices (those paid by the patient) due to health insurance. The insurer, in designing the benefit, decides what prices patients pay out-of-pocket for drugs and other products. In this primer we characterize cost and supply conditions in markets for generic and branded drugs, and apply basic tools of microeconomics to describe how an insurer, acting on behalf of its enrollees, would set demand prices for drugs. Importantly, we show how the market structure on the supply side, characterized alternatively by monopoly (unique brands), Bertrand differentiated product markets (therapeutic competition), and competition (generics), influences the insurer's choices about demand prices. This perspective sheds light on the choice of coinsurance versus copayments, the structure of tiered formularies, and developments in the retail market
Improving risk equalization with constrained regression by Richard van Kleef( )

9 editions published between 2015 and 2016 in English and held by 71 WorldCat member libraries worldwide

Several countries rely on regulated health plan competition to combine affordability of health plans with incentives for cost containment and quality improvement. Typically, these policies include premium regulation supplemented with risk equalization to compensate health plans for predictable variation in medical spending. An extensive empirical literature shows, however, that even the state-of-the-art risk equalization models undercompensate some risk groups and overcompensate others, leaving systematic incentives for risk selection. A natural approach to reducing under or overcompensation for a group is to include membership in that group as an indicator in the risk equalization model. For several types of indicators, however, inclusion can be problematic or infeasible. This paper introduces and illustrates an alternative approach to reducing over or undercompensation in such cases: constraining the estimated coefficients of the risk equalization model so as to limit over or undercompensation. Our empirical illustration is based on administrative data on medical spending and risk characteristics of nearly all individuals with basic health insurance in the Netherlands. We evaluate empirically the benefits of constraints in terms of reduced under or overcompensation on indicators omitted from the Dutch risk equalization model and their costs in terms of increased under or overcompensation on indicators included in the model. Our findings imply that the benefits of introducing constraints can be worth the costs. Constrained regression adds a tool for developing risk equalization models that can improve the overall economic performance of health plan payment schemes
Risk adjustment of health plan payments to correct inefficient plan choice from adverse selection by Jacob Glazer( )

5 editions published in 2014 in English and held by 69 WorldCat member libraries worldwide

This paper develops and implements a statistical methodology to account for the equilibrium effects (aka adverse selection) in design of risk adjustment formula in health insurance markets. Our setting is modeled on the situation in Medicare and the new state Exchanges where individuals sort themselves between a discrete set of plan types (here, two). Our "Silver" and "Gold" plans have fixed characteristics, as in the well-known research on selection and efficiency by Einav and Finkelstein (EF). We build on the EF model in several respects, including by showing that risk adjustment can be used to achieve the premiums that will lead to efficient sorting. The target risk adjustment weights can be found by use of constrained regressions, where the constraints in the estimation are conditions on premiums that should be satisfied in equilibrium. We illustrate implementation of the method with data from seven years of the Medical Expenditure Panel Survey
Do "reverse payment" settlements of brand-generic patent disputes in the pharmaceutical industry constitute an anticompetitive pay for delay? by Keith Drake( )

5 editions published in 2014 in English and held by 68 WorldCat member libraries worldwide

Brand and generic drug manufacturers frequently settle patent litigation on terms that include a payment to the generic manufacturer along with a specified date at which the generic would enter the market. The Federal Trade Commission contends that these agreements extend the brand's market exclusivity and amount to anticompetitive divisions of the market. The parties involved defend the settlements as normal business agreements that reduce business risk associated with litigation. The anticompetitive hypothesis implies brand stock prices should rise with announcement of the settlement. We classify 68 brand-generic settlements from 1993 to the present into those with and without an indication of a "reverse payment" from the brand to the generic, and conduct an event study of the announcement of the patent settlements on the stock price of the brand. For settlements with an indication of a reverse payment, brand stock prices rise on average 6% at the announcement. A "control group" of brand-generic settlements without indication of a reverse payment had no significant effect on the brands' stock prices. Our results support the hypothesis that settlements with a reverse payment increase the expected profits of the brand manufacturer and are anticompetitive
Tradeoffs in the design of health plan payment systems : fit, power and balance by Michael Geruso( )

5 editions published in 2014 in English and held by 68 WorldCat member libraries worldwide

In many markets, including the new U.S. Exchanges, health plans are paid by risk-adjusted capitation, in some markets combined with reinsurance and other payment features. This paper proposes three metrics for grading these complex payment systems: fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement these metrics in a study of Exchange payment systems with data similar to that used to develop the Exchange risk adjustment scheme and describe the tradeoffs among the metrics. We find that a simple reinsurance system scores better on fit, power and balance than the risk adjustment formula in use in the Exchanges
Risk corridors and reinsurance in health insurance marketplaces : insurance for insurers by Timothy J Layton( )

6 editions published in 2014 in English and held by 68 WorldCat member libraries worldwide

In order to encourage entry and lower prices, most regulated markets for health insurance include policies that seek to reduce the uncertainty faced by insurers. In addition to risk adjustment of premiums paid to plans, the Health Insurance Marketplaces established by the Affordable Care Act implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer's distribution of expected costs. This paper considers the economic costs and consequences of reinsurance and risk corridors. Drawing a parallel to individual insurance principles first described by Arrow (1963) and Zeckhauser (1970), we first discuss the optimal insurance policy for insurers. Then, we simulate the insurer's cost distribution under reinsurance and risk corridors using health care utilization data for a group of individuals likely to enroll in Marketplace plans from the Medical Expenditure Panel Survey. We compare reinsurance and risk corridors in terms of insurer risk reduction and incentives for cost containment, finding that one-sided risk corridors achieve more risk reduction for a given level of cost containment incentives than both reinsurance and two-sided risk corridors. We also find that the ACA policies being implemented in the Marketplaces (a mix of reinsurance and two-sided risk corridor policies) substantially limit insurer risk but that they are outperformed by a simpler one-sided risk corridor policy according to our measures of insurer risk and incentives
Premium transparency in the Medicare Advantage market : implications for premiums, benefits, and efficiency by Karen Stockley( )

5 editions published in 2014 in English and held by 68 WorldCat member libraries worldwide

We argue that the way premium information is communicated to consumers influences the way in which plans pass through subsidy dollars and can account for the empirical results. More specifically, institutional features make it difficult for consumers to observe a large component of the plan premium, leading to a lack of demand response to premium reductions below the premium charged by traditional Medicare (the fee-for-service Part B premium). When demand does not respond to lower premiums, plans have an incentive to pass-through cost subsidies to consumers via more generous benefits that consumers may not value at cost, creating an inefficiently high level of benefit generosity. Our results provide evidence that a lack of premium transparency in the MA market may distort the combination of premium levels and benefit generosity offered in equilibrium, resulting in some degree of inefficiently high benefits. We conclude by discussing changes to the choice environment that would increase premium transparency and potentially soften the premium rigidities we find
Assessing incentives for adverse selection in health plan payment systems by Timothy J Layton( )

5 editions published in 2015 in English and held by 67 WorldCat member libraries worldwide

Health insurance markets face two forms of adverse selection problems. On the demand side, adverse selection leads to plan price distortions and inefficient sorting of consumers across health plans. On the supply side, adverse selection creates incentives for plans to inefficiently distort benefits to attract profitable enrollees. These problems can be addressed by features of health plan payment systems such as reinsurance, risk adjustment, and premium categories. In this paper, we develop Harberger- type measures of the efficiency consequences of price and benefit distortions under a given payment system. Our measures are valid, that is, based on explicit economic models of adverse selection. Our measures are complete, in that they are able to incorporate multiple features of plan payment systems. Finally, they are practical, in that they are based on the ex ante data available to regulators and researchers during the design phase of payment system development, prior to observing actual insurer and consumer behavior. After developing the measures, we illustrate their use by comparing the performance of the payment system planned for implementation in the ACA Marketplaces in 2017 to several policy alternatives. We show that, in protecting against both types of selection problems, a payment system that incorporates reinsurance and prospective risk adjustment out-performs the planned payment system which includes only concurrent risk adjustment
Premium levels and demand response in health insurance : relative thinking and zero-price effects by R. C Douven( )

5 editions published in 2017 in English and held by 66 WorldCat member libraries worldwide

In health care systems with a competitive health insurance market, governments or other sponsors (e.g. employers) often subsidize premiums to encourage enrolment. These subsidies are typically independent of plan choice leaving the absolute premium differences in place so as not to distort consumer choice of plan. Such subsidies do, however, change the relative premium differences across plans, which, according to theories from behavioral economics, can affect choice. Consumers might be sensitive to differences relative to a reference premium ("relative thinking"). Furthermore, consumers might be particularly sensitive to a reference premium of zero ("zero-price effect"), a relevant range for some subsidized health insurance markets. This paper tests these ideas with two sources of evidence. We argue that observed equilibria in Germany and the U.S. Medicare Advantage markets are consistent with a powerful zero-price effects, resulting in an equilibrium focal pricing at zero. This contrasts with the Netherlands where equilibrium premiums are well above zero. In an empirical test using hypothetical questions in a web-based survey in these three countries, we also find evidence for both a relative thinking and a zero-price effect in the demand for health insurance. Our findings imply that well-designed subsidies can leverage relative thinking to increase demand elasticity for health plans. Creation of a powerful reference price (e.g., at zero), however, risks subverting price competition
Deriving risk adjustment payment weights to maximize efficiency of health insurance markets by Timothy J Layton( )

7 editions published in 2016 in English and held by 65 WorldCat member libraries worldwide

Risk adjustment of payments to health plans is fundamental to regulated competition among private insurers, which serves as the basis of national health policy in many countries. To date, estimation and evaluation of a risk adjustment model has been a two-step process. In a first step, the risk-adjustment payment weights are estimated using statistical techniques, generally ordinary-least squares, to maximize some statistical objective such as the R-squared; then, in a second step, the risk adjustment model is evaluated, usually with simulation methods, but without an explicit framework describing the objective of the model. This paper first develops such a framework and then uses it to replace the two-step "estimate-then-evaluate" approach with a one-step "estimate-to-maximize-the-objective" approach. We assume that the objective of risk adjustment is to minimize the loss from service-level distortions due to adverse selection incentives, and we derive expressions for the service-level distortions as a linear function of the risk adjustment payment weights. We show that when the number of risk adjustor variables exceeds the number of decisions plans make about service allocations, incentives for service-level distortion can always be eliminated. Under these circumstances the welfare maximizing payment weights can be found with a constrained least-squares regression where the constraints are the conditions under which plan actions achieve efficiency. We illustrate this method with the data used to estimate risk adjustment payment weights in the Netherlands (N=16.5 million). When the number of "services" exceeds the number of available risk adjustors, however, it is not possible to eliminate incentives for service-level distortion. In this case, a regression on transformed data produces the (second-best) payment weights that minimize welfare loss
Marketplace plan payment options for dealing with high-cost enrollees by Timothy J Layton( )

6 editions published in 2016 in English and held by 63 WorldCat member libraries worldwide

Two of the three elements of the ACA's "premium stabilization program," reinsurance and risk corridors, are set to expire in 2017, leaving risk adjustment alone to protect plans against risk of high-cost cases. This paper considers potential modifications of the HHS risk adjustment methodology to maintain plan protection against risk from high-cost cases within the current regulatory framework. We show analytically that modifications of the transfer formula and of the risk adjustment model itself are mathematically equivalent to a conventional actuarially fair reinsurance policy. Furthermore, closely related modifications of the transfer formula or the risk adjustment model can improve on conventional reinsurance by figuring transfers or estimating risk adjustment model weights recognizing the presence of a reinsurance function. In the empirical section, we estimate risk adjustment models with an updated and selected version of the data used to calibrate the federal payment models, and show, using simulation methods, that proposed modifications improve fit at the person level and protect small insurers against high-cost risk better than conventional reinsurance. We simulate various "attachment points" for the reinsurance equivalent policies and quantify the tradeoffs of higher and lower attachment points
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Handbook of health economics
Alternative Names
MacGuire, Thomas 1950-

MacGuire, Thomas G. 1950-

MacGuire, Thomas Gregory 1950-

MacGuire, Tom 1950-

Mc Guire, Thomas G. 1950-

McGuire, Thomas

McGuire, Thomas 1950-

McGuire, Thomas G.

McGuire, Thomas Gregory 1950-

McGuire, Tom 1950-

English (178)