NBER

Olesya Fomenko

Workers Compensation Research Institute
955 Massachusetts Ave
Cambridge, MA 02460

E-Mail: EmailAddress: hidden: you can email any NBER-related person as first underscore last at nber dot org
Institutional Affiliation: WCRI

NBER Working Papers and Publications

May 2019Reclassification to Avoid Consumer Cost-Sharing in Group Health Plans
with Jonathan Gruber: w25870
We examine how consumers respond to being effectively double insured under two systems: group health (GH) and workers’ compensation (WC). Many GH plans have substantial consumer cost-sharing burden, while WC coverage has no cost-sharing for medical services for work-related injuries. As a result, a consumer facing a large deductible under their group health plan will have a strong financial incentive to make a claim under WC instead. We use a unique data set of claims under both GH and WC to study how “case shifting” to WC responds to GH deductibles for the most common set of injuries that are covered under both types of insurance. We identify the impact of case shifting by using interactions of deductible levels and previous spending. We find that a typical claim is about 1.4 percentage p...
June 2016Claims-Shifting: The Problem of Parallel Reimbursement Regimes
with Jonathan Gruber: w22318
Parallel reimbursement regimes, under which providers have some discretion over which payer gets billed for patient treatment, are a common feature of health care markets. In the U.S., the largest such system is under Workers’ Compensation (WC), where the treatment workers with injuries that are not definitively tied to a work accident may be billed either under group health insurance plans or under WC. We document that there is significant reclassification of injuries from group health plans into WC, or “claims shifting”, when the financial incentives to do so are strongest. In particular, we find that injuries to workers enrolled in capitated group health plans (such as HMOs) see a higher incidence of their claims for soft-tissue injuries under WC than under group health, relative to t...

Published: Olesya Fomenko & Jonathan Gruber, 2017. "Claims-shifting: The problem of parallel reimbursement regimes," Journal of Health Economics, vol 51, pages 13-25.

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