Health Care Financing

JSI's active research program addresses both private and public sector health insurance and financing issues. We have conducted employer health insurance surveys among large, medium, and small firms to document employers' health purchasing practices, to track changes in health benefits on time, and to evaluate their effects on access, quality and cost. In addition, JSI staff have designed and evaluated programs to increase access to health insurance for employed workers, expand coverage for the uninsured, and to determine the factors involved in consumers' health purchasing decisions.

Please note the following are listed in chronological order starting with the most recent publication.

Developing Foci and Criteria for The Fund for a Healthy Rhode Island (PDF, 34 KB)

JSI worked with The Rhode Island Foundation to develop recommendations for the Foundation concerning the use of the Fund for a Healthy Rhode Island. The report delivers qualitative analysis and strategic recommendations on how to effectively utilize the Fund for a Healthy Rhode Island to achieve impact. Of particular relevance is the impact on the provision of quality and affordable health care services in the state. The report delineates four critical recommendations that will ultimately help enhance and transform the primary care system in the state of Rhode Island. John Snow, Inc., September 2008.

Making a Case for Quality: The Business Case for Tricare Health Promotion Programs—Health and Work Performance Questionnaire (HPQ): DOD Edition (PDF, 1,093 KB)

The US military collects a large amount of data on health and injuries, but does not routinely link information about service members' health with work performance measures. The Health and Work Performance Questionnaire (HPQ) measures the relationship between health and work performance in the civilian sector; the Department of Defense contracted with JSI to adapt and pilot the HPQ for a military population. This report details the rationale for the utility of the questionnaire for the military, outlines the variations from the civilian version, and recommends processes for administration to military populations. James Maxwell, Eugenie Coakley, Emilie Pinkham, Ronald Kessler, Milly Krakow. John Snow, Inc., Boston, MA. 2006.

Rhode Island Employer Survey, 2005: Employers Satisfied with Rite Share: Report on Rhode Island's Premium Assistance Program (PDF, 52 KB)

Rhode Island's Rite Share program is one of the oldest employer premium assistance programs in the country. Enrollment in the program is mandatory for Medicaid-eligible workers with access to more cost-effective employer-sponsored insurance. In 2005, JSI conducted an extensive survey of RI employers' experiences with health benefits for their employees. This project involved a statewide survey of health insurance coverage costs and impacts on business, as well as a supplemental survey for employers who were identified by the state as having employees enrolled in Rite Share. This report presents the findings on employers with RIte Share employees. James Maxwell, Saminaz Zaman, Mihaly Imre, Eugenie Coakley. JSI Research & Training Institute, Inc., Boston, MA, 2006.

Market Watch: Are California's Large Employers Moving to Catastrophic Health Insurance Coverage (PDF, 102 KB)

Large employers in California are experimenting with new health benefit and insurance options as premium rates continue to escalate. This study examines the offer and penetration rates of catastrophic coverage insurance products, including high-deductible PPO and consumer-driven health plans, among large CA employers before the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was passed. Only a few employers offered these plans, and they did not provide adequate incentives for their workers to accept. CA employers, like the rest of the nation, implemented these plans as alternatives rather than replacements to their current plan choices. James Maxwell, Peter Temin, Saminaz Zaman, Tanaz Petigara. Health Affairs/Project HOPE—The People-to-People Health Foundation, Inc. 2005. Health Affairs web exclusive.

Russia MCHI Leveraging Study (PDF, 190 KB)

The Maternal and Child Health Initiative (MCHI) has been extremely successful in strengthening maternal and child health services in the Russian Federation through the adoption of internationally recognized standards. One of the factors that helped to achieve such results in a relatively short time period was MCHI's ability to leverage resources for program implementation. This study was conducted in 2006 to document MCHI's leveraging processes and achievements. The study found that MCHI was extremely successful in leveraging a range of resources to support program implementation, expansion, and future sustainability. Lisa Hare, T. Makarova, JSI/MCHI, September 2006.

Rhode Island Employer Survey, 2005: Final Report—Prepared for the Rhode Island Department of Human Services (PDF, 147 KB)

Rhode Island employers face a continuing crisis of rising health care costs that affect not only their total compensation, but also their profitability and competitiveness in the marketplace. In 2005 JSI conducted an extensive survey of RI employers' experiences with health benefits for their employees. Employers were asked about the costs of their coverage, contribution levels, plan types, workforce composition, and strategies for the future. This report to the Rhode Island Department of Human Services presents the survey findings. A key trend between 1999 and 2005 is that health insurance offer rates are declining, especially among small employers. This decline is particularly striking in low wage industries such as retail and service sector jobs, affecting low wage earners disproportionately. Eligibility rates are also declining, and dramatically so for part-time workers. Employer policies regarding minimal hourly requirements for eligibility for health insurance have become much more restrictive over the last six years. Employee acceptance of health insurance coverage has also dropped since 1999. A number of factors including greater employee cost-sharing are responsible for this trend. James Maxwell, Saminaz Zaman, Mihaly Imre, Eugenie Coakley. JSI Research & Training Institute, Inc. Boston, MA. 2005.

Rhode Island Employer Health Insurance Survey, 2005: Report to Rhode Island Businesses (PDF, 872 KB)

Health Care Purchasing Among Large Private and Public Employers in California (PDF, 1.66 MB)

This report by JSI Research & Training Institute, Inc. presents the findings from a comprehensive survey of health purchasing practices among 318 of California's largest private and public employers. Conducted by researchers at the JSI Research & Training Institute and the Massachusetts Institute of Technology, the survey attained a response rate of 85 percent, presenting an accurate view of health benefits among large employers in California. 2004.

Social Franchising Health Services: A Philippines Case Study and Review of Experience (PDF, 12.2 MB)

This monograph documents the work of the USAID-funded TANGO Project to establish a franchise of Well-Family Midwife Clinics throughout the Philippines. Included are lessons learned in developing a sustainable franchise, as well as examples of social franchising from other countries and programs. JSI/TANGO Project, 2004.

Private Health Purchasing Practices In The Public Sector: A Comparison Of State Employers And The Fortune 500 (PDF, 102 KB)

State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs. James Maxwell, Peter Temin and Tanaz Petigara. Health Affairs, March/April 2004.

Corporate Management of Quality in Employee Health Plans (PDF, 153 KB)

As large companies move their employees into managed care, they must concern themselves with the quality and price of their employees' health care. Based on a survey of Fortune 500 companies, this report shows that most Fortune 500 companies are integrating several aspects of quality into their purchasing and contracting decisions by focusing on three dimensions of quality—customer service, network composition, and clinical quality. James Maxwell, Peter Temin. Lippincott Williams & Wilkins, Inc. Health Care Management Review, Series volume 2003, vol. 28 (1), pages 29-42.

The Benefits Divide: Health Care Purchasing in Retail Versus Other Sectors (PDF, 102 KB)

This study compares health care purchasing in the retail versus other sectors of the Fortune 500. Employing millions of low-wage workers, the retail sector is the largest employer of uninsured workers in the economy. This study found that retail companies are using the same competitive bidding process that other companies use to obtain a given level of coverage for the lowest possible cost. They are more price-oriented, however, than other Fortune 500 companies. The most striking disparity lies in the nearly fivefold difference in offer rates for health care coverage. James Maxwell, Saminaz Zaman, Peter Temin. Project Hope—The People-to-People Health Foundation, Inc. Health Affairs. Volume 21, Number 5, September-October 2002.

Corporate Health Care Purchasing Among the Fortune 500 (PDF, 1,512 KB)

This report presents the results of the first academic study of health purchasing practices by large companies to address the ongoing challenge of managed care. The data for this report were collected during the winter and spring of 1999-2000 from companies on the Fortune 500 list of the largest public US firms. The research showed that the managed care revolution is nearly over; the vast majority of Fortune 500 employees are now enrolled in managed care models rather than in traditional indemnity. James Maxwell, Forrest Briscoe, Corey Watts, Saminaz Zaman, Peter Temin. Washington, D.C.: National Health Care Purchasing Institute, 2001.

Contracting for Health Care Service Delivery: A Manual for Policy Makers (PDF, 148 KB)

The last decade or so has seen a number of important changes in the mix of public and private services in the health sector and in the organization of those services throughout the developing world. Governments are looking for ways to increase efficiency in the use of public sector resources, improve the quality of health care, and extend health services to underserved populations. Public-private partnerships can help government agencies deliver more cost-effective health services to target populations. "Contracting for Health Care Service Delivery: A Manual for Policymakers" offers a brief overview of the benefits—and limits—of using contracts for service delivery, and describes some of the steps that are key to good contract management. Although there exists a wide range of types of contracts, this manual focuses on performance-based contracting.

Managed competition in practice: 'value purchasing' by fourteen employers (PDF, 239 KB)

Many large U.S. companies have transformed their procurement of health benefits in the 1990s by combining the principles of managed competition with other business tactics to create a business-savvy hybrid of the private sector's own design, often referred to as "value purchasing." Until recently, few policymakers or health care observers believed that large firms would be a force in health system reform. Yet to implement value purchasing, the large companies in this study created new organizational forms, provided employees with financial incentives to select low-cost health plans, and used business tactics such as competitive bidding to negotiate more favorable rates and to improve quality among health plans. The financial results were impressive for the companies studied. In addition, the companies' demands on the health care delivery system are multiplying as the interface between business firms and health care organizations changes. These demands will only increase as the practices we found become more widespread. James Maxwell, Forrest Briscoe, S. Davidson, L. Eisen, Mark Robbins, Peter Temin, and C. Young. Managed competition in practice: 'value purchasing' by fourteen employers, Health Affairs, May/June 1998; 17(3): 216-226.