NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Olesya Fomenko

Workers Compensation Research Institute
955 Massachusetts Ave
Cambridge, MA 02460

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NBER Working Papers and Publications

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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