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.

For JSI-authored articles in peer-reviewed journals please go to Journal Articles.

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

Community Health Workers: Exploring Volunteerism as a Sustainability Model Policy Brief (PDF, 240 KB)

This brief presents the findings of a qualitative study exploring the potential of non-financial incentives (NFIs) in motivating voluntary Community Health Workers (vCHWs) in four of the largest regions in Ethiopia.

Identifying Indicators for Performance-Based Contracting is Key: The Case of Liberia (PDF, 582 KB)

Performance-based contracting (PBC) has been adopted in Liberia, where NGOs are contracted to manage and support Ministry of Health and Social Welfare (MOHSW) health facilities, and also to build MOHSW capacity in the process. Performance-based contracting rewards the contracted party upon achievement or progress toward pre-agreed targets with either financial or non-financial (e.g., attending training) incentives. As PBC focuses on results, the identification and selection of indicators is vital. This case study describes the rationale and the process followed in selecting indicators for the PBC of NGOs through the Rebuilding Basic Health Services (RBHS) project in Liberia. As such, the report endeavors to make a contribution to lessons learned about PBC design and implementation. Richard J. Brennan, Deirdre Rogers, Shiril Sarcar, and Petra Vergeer, The World Bank, 2010.

Non-Financial Incentives for Voluntary Community Health Workers: A Qualitative Study (PDF, 701 KB)

The Ethiopia health extension program extends its reach through a diverse network of voluntary Community Health Workers (vCHWs), who spread health messages and practices to families residing in every part of a community or kebele. One of the objectives of the Last 10 Kilometers (L10K) project is to ensure the sustained engagement of these volunteers through non-financial incentives (NFIs). The NFIs proposed by L10K are mechanisms that recognize vCHWs' work; support from Health Extension Workers in the form of ongoing mentoring, training and follow-up, certification, performance reviews, and support by kebele and woreda (i.e., district) leaders. Successful communities and families are rewarded, celebrations are organized periodically, badges and ID cards are provided - in addition to other identification methods like posting their photographs at public places, as well as the provision of refreshments during performance review meetings. Through in-depth interviews and focus group discussions, this study explores the potential efficacy of NFIs proposed by the project. The results of the study outline factors motivating vCHWs, indicate other NFI mechanisms for consideration, and suggest programmatic recommendations. Yared Amare, JSI/Last 10 Kilometers Project, 2009.

Developing Foci and Criteria for The Fund for a Healthy Rhode Island (PDF, 35 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.

Russia MCHI Leveraging Study (PDF, 194 KB)

The Maternal and Child Health Initiative (MCHI) was 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 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. Hare, L., Makarova, T., JSI/MCHI, September 2006.

Making a Case for Quality: The Business Case for Tricare Health Promotions Programs: Health and Work Performance Questionnaire (HPQ): DoD Edition (PDF, 6.39 MB)

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, 53 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, 105 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.

Rhode Island Employer Health Insurance Survey 2005: Report to Rhode Island Businesses (PDF, 893 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 the spring of 2005, the Rhode Island Department of Human Services contracted with JSI Research and Training Institute, Inc. to conduct 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 RI businesses presents the survey findings. James Maxwell, Saminaz Zaman, Rachel Kohn, Eugenie Coakley. JSI Research & Training Institute, Inc. 2005.

Rhode Island Employer Survey 2005: Final Report Prepared for the Rhode Island Department of Human Services (PDF, 150 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 the spring of 2005, the Rhode Island Department of Human Services contracted with JSI Research and Training Institute, Inc. to conduct 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. James Maxwell, Saminaz Zaman, Mihaly Imre, Eugenie Coakley. JSI Research & Training Institute, Inc. 2005.

Guidelines for Assessing Costs in a Logistics System: An Example of Transport Cost Analysis (PDF, 667 KB)

This guide was developed to help address one of the areas of unmet need in financial analysis: the definition of an approach for designing and conducting a cost analysis. JSI/DELIVER Project, 2004.

Contracting for Health Care Service Delivery: A Manual for Policymakers (PDF, 152 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. Wendy Abramson/JSI. June 2004.

Health Care Purchasing Among Private and Public Employers in California (PDF, 1.74 MB)

This report 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. JSI Research & Training Institute, Inc. 2004

Social Franchising Health Services: A Philippines Case Study and Review of Experience (PDF, 742 KB)

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.

Corporate Management of Quality in Employee Health Plans (PDF, 156 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. 2003.