June 2010

You are currently browsing the monthly archive for June 2010.

Over the last 15 years, Income Inequality has decreased?

June 2, 2010 in Economics - General, Health Insurance | 6 comments

Many economists have lamented that income inequality has grown over recent decades.  Although it is true that wage inequality has increased, compensation inequality may not have.  When I mention “compensation inequality,” I refer to the total package of compensation that a worker receives.  This includes wages, health insurance, 401(k) benefits, and other non-wage forms of compensation.  In previous posts, I have mentioned that once health insurance is taken into account, inequality may in fact be shrinking.

A recent NBER working paper by Burkhauser and Simon (2010) also shows that inquality is in fact decreasing once one taking into account health insurance costs.  This chart provides information on changes in income and total income between 1995 and 2008.  Income includes only raw wages, but “total income” also takes into account workers compensation in the form of health insurance.  The authors use this evidence to claim that “…ignoring the value of health insurance coverage will substantially understate the level of economic well being of Americans and its upward trend and overstate the level of inequality and its upward trend.”

Read the rest of this entry »

Tags: , , ,

Non-VA VA Care

June 1, 2010 in Supply of Medical Services | No comments

Veterans Affairs is is responsible for administering programs of veterans’ benefits for veterans, their families, and survivors.  In 2009, the VA had a budget of $87.6 billion and employed nearly 280,000 people at hundreds of Veterans Affairs medical facilities, clinics, and benefits offices.

The VA is often held up a the model for integrated care. Physicians work on a salaried basis.  Patient generally only receive treatment from VA facilities.

Sometimes, however, the VA is not able to provide care in house.  In this case, the Non-VA Purchased Care Program fills this void. The Purchase Care Program supplements rather than replaces the standard VA health care.  Reasons why beneficiaries would access the Purchased Care Program include:

  • Beneficiaries not able to access VA health care facilities
  • Demand exceeds VA health care facility capacity
  • Need for diagnostic support services for VA clinicians
  • Need for scarce specialty resources (e.g., obstetrics, hyperbaric, burn care, oncology) and/or when VA resources are not available due to constraints (e.g. staffing, space)
  • Satisfying patient wait-time requirements
  • Ensure cost-effectiveness for VA (whereby outside procurement vs. maintaining and operating like services in VA facilities and/or infrequent use is more appropriate)

The Purchased Care Program has expanded over the years.  In fiscal year 2005, the PCP program served about 500,000 veterans and had program expenses of $1.5 billion.  By FY2008, the program served almost 800,000 veterans had had expenses of over $3 billion.   FY08 expenses include:

  • 35% for pre-authorized outpatient care,
  • 22% for pre-authorized inpatient care,
  • 14% for community nursing home services,
  • 12% for home health services,
  • 9% for military care,
  • 5% for unauthorized care, and
  • 3%  for other services.

Tags: ,

Newer entries »