Effects of state reinsurance programs on health insurance exchange premiums and insurer participation

Objective

The aim of the study was to estimate the effect of the state-based reinsurance programs through the section 1332 State Innovation Waivers on health insurance marketplace premiums and insurer participation.

Data Source

2015 to 2022 Robert Wood Johnson Foundation Health Insurance Exchange Compare Datasets.

Study Design

An event study difference-in-differences (DD) model separately for each year of implementation and a synthetic control method (SCM) are used to estimate year-by-year effects following program implementation.

Data Collection/Extraction Methods

Not applicable.

Principal Findings

Reinsurance programs were associated with a decline in premiums in the first year of implementation by 10%–13%, 5%–19%, and 11%–17% for bronze, silver, and gold plans (p < 0.05). There is a trend of sustained declines especially for states that implemented their programs in 2019 and 2020. The SCM analyses suggest some effect heterogeneity across states but also premium declines across most states. There is no evidence that reinsurance programs affected insurer participation.

Conclusion

State-based reinsurance programs have the potential to improve the affordability of health insurance coverage. However, reinsurance programs do not appear to have had an effect on insurer participation, highlighting the need for policy makers to consider complementary strategies to encourage insurer participation.     

北京市某社区15例恢复期精神疾病患者生存压力调查

目的 了解生活在社区的恢复期精神疾病患者在疾病康复过程中的生存压力。方法 2017年8月至2018年1月,选取北京市某社区15例恢复期精神疾病患者,通过半结构式访谈的方式收集资料,以Colaizzi 7步分析法分析资料。结果 得出4个主题:精神疾病症状和药物不良反应等引起的生理性压力;因疾病转归和日常生活角色冲突产生的精神心理性压力;社会歧视、缺乏工作机会和难以获取社会福利资源等带来的社会环境压力;贬低歧视和家庭亲属关系恶化导致的人际交往压力。结论 恢复期精神疾病患者重返家庭和社会后存在明显的生存压力,压力源包括疾病症状、社会歧视、人际关系等多个方面,因此,应注重消除精神疾病患者的自我歧视,完善社会支持与社会福利体系,增加个性化的社区精神康复活动,以减轻患者生存压力,促进其康复。     

Correlates of Mental Illness and Health Categories among Older Adults in China: An Empirical Study Based on the Two Continua Model

Objective: Keyes’ two continua model is a useful concept in which mental health and mental illness exist on two separate axes. Based on this model, this study examined the prevalence and correlates of three mental health categories among older adults in China.

Methods: Cross-sectional data were derived from Wave 1 of the Study on Global AGEing and Adult Health. Participants were categorized into complete mental health (CMH), complete mental illness (CMI), and moderate mental health (MMH) groups. Multinomial logistic regressions were used.

Results: The prevalence of CMH, CMI, and MMH in China was 18%, 16%, and 66%, respectively. Being female, unmarried, younger, and feeling unhealthy were more likely to result in placement in the CMI category. Employment, education, and cognitive function were identified as important protective factors of CMH. Age, income, urban or rural residence, and physical function difficulty were associated with all three categories.

Discussion: We demonstrated the utility of the two continua model in identifying mental health needs in Chinese contexts. The findings suggest that future policy reforms and clinical interventions should establish a more comprehensive mental health category as a screening tool nationwide. The promotion of social engagement could play an important role in treating mental illness and improving positive mental health.