Mark V. Pauly

In this book, distinguished scholars Philip A. Rea, Mark V. Pauly, and Lawton R. Burns explore the science and management behind marketable biomedical innovations. They look at how the science actually played out through the interplay of personalities, the cultures within and between academic and corporate entities, and the significance of serendipity not as a mysterious phenomenon but one intrinsic to the successes and failures of the experimental approach. With newly aggregated data and case studies, they consider the fundamental economic underpinnings of investor-driven discovery management, not as an obstacle or deficiency as its critics would contend or as something beyond reproach as some of its proponents might claim, but as the only means by which scientists and managers can navigate the unknowable to discover new products and decide how to sell them so as to maximize the likelihood of establishing a sustainable pipeline for still more marketable biomedical innovations.

In this book, distinguished scholars Philip A. Rea, Mark V. Pauly, and Lawton R. Burns explore the science and management behind marketable biomedical innovations. They look at how the science actually played out through the interplay of personalities, the cultures within and between academic and corporate entities, and the significance of serendipity not as a mysterious phenomenon but one intrinsic to the successes and failures of the experimental approach. With newly aggregated data and case studies, they consider the fundamental economic underpinnings of investor-driven discovery management, not as an obstacle or deficiency as its critics would contend or as something beyond reproach as some of its proponents might claim, but as the only means by which scientists and managers can navigate the unknowable to discover new products and decide how to sell them so as to maximize the likelihood of establishing a sustainable pipeline for still more marketable biomedical innovations.

This book examines the behavior of individuals at risk and insurance industry decision makers involved in selling, buying and regulation. It compares their actions to those predicted by benchmark models of choice derived from classical economic theory. Where actual choices stray from predictions, the behavior is considered to be anomalous. Howard C. Kunreuther, Mark Pauly and Stacey McMorrow attempt to understand why these anomalies occur, in many cases using insights from behavioral economics. The authors then consider if and how such behavioral anomalies could be modified to improve individual and social welfare. This book describes situations in which both public policy and the insurance industry's collective posture need to change. This may require incentives, rules and institutions to help reduce both inefficient and anomalous behavior, thereby encouraging behavior that will improve individual and social welfare.

This book examines the behavior of individuals at risk and insurance industry decision makers involved in selling, buying and regulation. It compares their actions to those predicted by benchmark models of choice derived from classical economic theory. Where actual choices stray from predictions, the behavior is considered to be anomalous. Howard C. Kunreuther, Mark Pauly and Stacey McMorrow attempt to understand why these anomalies occur, in many cases using insights from behavioral economics. The authors then consider if and how such behavioral anomalies could be modified to improve individual and social welfare. This book describes situations in which both public policy and the insurance industry's collective posture need to change. This may require incentives, rules and institutions to help reduce both inefficient and anomalous behavior, thereby encouraging behavior that will improve individual and social welfare.

Mark V. Pauly offers a detailed look at the individual insurance market in the United States. He explains how it works, suggests approaches to improvement that build on what currently works well, and provides a realistic assessment of how much improvement we can demand and expect. He concludes that, although there are some serious deficiencies in today's individual insurance market, there are also some important advantages in this market that should be preserved.

As Congress contemplates major revisions to America's health care system, two leading health economists warn that significant differences among state Medicaid programs will hinder national health care reform. Thomas W. Grannemann and Mark V. Pauly argue that Medicaid will need to be reformed as an early step in any serious health care reform effort. While states such as Mississippi and Nevada spend as little as $5,000 per poor person annually, New York and Alaska annually spend more than $15,000 per Medicaid patient. Large differences remain even after correcting for cost-of-living and medical-price differences. This imbalance among states creates an uneven and unstable foundation for any national program to address the needs of uninsured Americans. The authors offer principles for reform designed to encourage equity, efficiency, and accountability in all publicly funded health care programs. They suggest changes in provider payment methods and federal/state financing designed to promote interstate equity, equality of payment across settings, claims-based accountability, provider network control, and value-based cost containment. Such reform will require upfront changes in Medicaid to improve access to high-value health care for low-income persons (particularly those in low-Medicaid-benefit states) and to help slow the rate of growth in medical costs. These changes will level the playing field for state programs and provide a crucial foundation for further national reform.

Considerable evidence suggests that many people for whom insurance is worth purchasing do not have coverage and others who appear not to need financial protection against certain events actually have purchased coverage. There are certain types of events for which one might expect to see insurance widely marketed are now viewed today by insurers as uninsurable and there are other policies one might not expect to be successfully marketed that exist on a relatively large scale. In addition, evidence suggests that cost-effective preventive measures are sometimes rewarded by insurers in ways that could change their clients' behaviour. These examples reveal that insurance purchasing and marketing activities do not always produce results that are in the best interest of individuals at risk. Insurance Decision Making and Market Behavior discusses such behaviour with the intent of categorizing these insurance "anomalies". It represents a first step in constructing a theory of insurance decision making to explain behaviour that does not conform to standard economic models of choice and decision-making. Finally, the authors propose a set of prescriptive solutions for improving insurance decision-making.

The 1990s saw no progress in the financing of health care. About 40 million Americans still have no health insurance including 22 percent of America's children and 19 percent of young adults. And an economic downturn brings with it increased numbers of uninsured. What can be done? Mark V. Pauly and John S. Hoff answer with a tax credit/voucher system introduced in a common-sense way, with as much simplicity and flexibility as possible. The United States can launch such a program immediately and make needed adjustments along the way. The use of the credit assists people in obtaining insurance and provides tax equity. The authors chronicle changes in U.S. attitudes about health care and in the economic environment, tackle design issues, and consider policy trade-offs and problems of the technicalities of such a program. They offer a sample tax-credit plan and respond to possible objections to their plan.

This study analyzes the effects of a variety of forms of tax credits, especially for workers whose incomes place them above the poverty line but below the median family income.

How are the costs of health insurance premiums determined? Should costs vary according to indicators of risk? How much do premiums vary with risk? Do the healthy subsidize the unhealthy? Should public subsidies vary according to economic status and risk? This book examines these questions.

The majority of Americans receive their health insurance for themselves and their families through their job. The employee pays a portion of the premium but the employer chooses the type and amount of coverage offered as well as administers the plan. This book addresses the question: Who really pays for employer-arranged health insurance? Are premiums paid from company profits or do employees bear the cost through lower wages? Pauly suggests that this confusion has complicated the debate on public policy and needs to be alleviated. This work first shows how views taken by business and political leaders during the Clinton health reform proposal debate were affected by this confusion and did not follow the economic view. It then provides a novel, intuitive, but comprehensive outline of the economic theory that bears on this question. Empirical evidence consistent with the economic view is summarized, and the implications of the view for some important issues in health policy and in practical health benefits management are discussed in detail. Health Benefits at Work explores the political economy of health policy when the stakeholders have an uncertain and possibly incorrect understanding of their actual interests. For the benefits specialist, it provides an accessible treatment of the complex and often counterintuitive economics of health benefits. This will appeal to the health policy community as well as economists and anyone concerned with issues surrounding health insurance in employment settings. "This book is refreshing . . . clean and intuitive; the logic devastating." --Michael A. Morrissey Mark V. Pauly is Professor of Health Care Systems and Insurance and Risk Management, The Wharton School, University of Pennsylvania.

Medical savings accounts (MSAs), an alternative to conventional health insurance, are designed to offer individuals the opportunity to save money while providing greater economic efficiency in the medical care sector. However, this study argues that MSAs are unlikely to lead to efficient spending.