Optimal coinsurance rates for a heterogeneous population under inequality and resource constraints

References

• Akan, M., Alagoz, O., Ata, B., Erenay, F.S. and Said, A. (2012) A broader view of designing the liver allocation system. Operations Research, 60(4), 757–770.
   Web of Science ®Google Scholar
• Anderson, K.M., Odell, P.M., Wilson, P.W. and Kannel, W.B. (1991) Cardiovascular disease risk profiles. American Heart Journal, 121(1), 293–298.
   PubMed Web of Science ®Google Scholar
• Arias, E. (2007) United States life tables, 2004. National Vital Statistics Reports, 56(9), 1–40.
   Google Scholar
• Ayer, T., Alagoz, O. and Stout, N.K. (2012) POMDP approach to personalize mammography screening decisions. Operations Research, 60(5), 1019–1034.
   Web of Science ®Google Scholar
• Ayer, T., Alagoz, O., Stout, N.K. and Burnside, E.S. (2016) Heterogeneity in women’s adherence and its role in optimal breast cancer screening policies. Management Science, 62(5), 1339–1362.
   Web of Science ®Google Scholar
• Bard, J.F. (1998) Practical Bilevel optimization: Algorithms and Applications,. Springer Science & Business Media, Boston, Massachusetts.
   Google Scholar
• Beune, E.J., van Charante, E.P.M., Beem, L., Mohrs, J., Agyemang, C.O., Ogedegbe, G. and Haafkens, J.A. (2014) Culturally adapted hypertension education (cahe) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: Cluster-randomized trial. PloS one, 9(3), e90103.
   PubMed Web of Science ®Google Scholar
• Bibbins-Domingo, K., Chertow, G.M., Coxson, P.G., Moran, A., Lightwood, J.M., Pletcher, M.J. and Goldman, L. (2010) Projected effect of dietary salt reductions on future cardiovascular disease. New England Journal of Medicine, 362(7), 590–599.
   PubMed Web of Science ®Google Scholar
• Bunting, B.A., Smith, B.H., and Sutherland, S.E. (2008) The Asheville project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. Journal of the American Pharmacists Association, 48(1), 23–31.
   PubMed Web of Science ®Google Scholar
• Calcott, P. (1999) Demand inducement as cheap talk. Health Economics, 8(8), 721–733.
   Web of Science ®Google Scholar
• Chernew, M.E., Juster, I.A., Shah, M., Wegh, A., Rosenberg, S., Rosen, A.B., Sokol, M.C., Yu-Isenberg, K. and Fendrick, A.M. (2010) Evidence that value-based insurance can be effective. Health Affairs, 29(3), 530–536.
   Web of Science ®Google Scholar
• Choudhry, N.K., Fischer, M.A., Avorn, J.L., Lee, J.L., Schneeweiss, S., Solomon, D.H., Berman, C., Jan, S., Lii, J., Mahoney, J.J. and Shrank, W.H. (2012) The impact of reducing cardiovascular medication copayments on health spending and resource utilization. Journal of the American College of Cardiology, 60(18), 1817–1824.
   PubMed Web of Science ®Google Scholar
• Choudhry, N.K., Patrick, A.R., Antman, E.M., Avorn, J. and Shrank, W.H. (2008) Cost-effectiveness of providing full drug coverage to increase medication adherence in post–myocardial infarction medicare beneficiaries. Circulation, 117(10), 1261–1268.
   PubMed Web of Science ®Google Scholar
• Cowell, F.A. (2000) Measurement of inequality, in Handbook of Income Distribution, volume 1, pp. 87–166.
   Google Scholar
• De Jaegher, K. and Jegers, M. (2001) The physician-patient relationship as a game of strategic information transmission. Health Economics, 10(7), 651–668.
   Web of Science ®Google Scholar
• Denoyel, V., Alfandari, L. and Thiele, A. (2017) Optimizing healthcare network design under reference pricing and parameter uncertainty. European Journal of Operational Research, 263(3), 996–1006.
   Web of Science ®Google Scholar
• Denton, B.T., Alagoz, O., Holder, A. and Lee, E.K. (2011) Medical decision making: Open research challenges. IIE Transactions on Healthcare Systems Engineering, 1(3), 161–167.
   Google Scholar
• Egan, B.M., Lackland, D.T. and Cutler, N.E. (2003) Awareness, knowledge, and attitudes of older Americans about high blood pressure: Implications for health care policy, education, and research. Archives of Internal Medicine, 163(6), 681–687.
   Google Scholar
• El-Amine, H., Bish, E.K. and Bish, D.R. (2018) Robust postdonation blood screening under prevalence rate uncertainty. Operations Research, 66(1), 1–17.
   Web of Science ®Google Scholar
• Erenay, F.S., Alagoz, O. and Said, A. (2014) Optimizing colonoscopy screening for colorectal cancer prevention and surveillance. Manufacturing & Service Operations Management, 16(3), 381–400.
   Web of Science ®Google Scholar
• Gibson, T.B., Mahoney, J., Ranghell, K., Cherney, B.J. and McElwee, N. (2011) Value-based insurance plus disease management increased medication use and produced savings. Health Affairs, 30(1), 100–108.
   PubMed Web of Science ®Google Scholar
• Gibson, T.B., Mark, T.L., Axelsen, K., Baser, O., Rublee, D.A. and McGuigan, K. A. (2006) Impact of statin copayments on adherence and medical care utilization and expenditures. The American Journal of Managed Care, 12, SP11–SP19.
   Google Scholar
• Gibson, T.B., Mark, T.L., McGuigan, K.A., Axelsen, K. and Wang, S. (2006) The effects of prescription drug copayments on statin adherence. The American Journal of Managed Care, 12(9), 509–517.
   Web of Science ®Google Scholar
• Goldman, D.P., Joyce, G.F. and Karaca-Mandic, P. (2006) Varying pharmacy benefits with clinical status: The case of cholesterol-lowering therapy. American Journal of Managed Care, 12(1), 21–28.
   Web of Science ®Google Scholar
• Grosse, S.D. (2008) Assessing cost-effectiveness in healthcare: History of the $50,000 per QALY threshold. Expert Review of Pharmacoeconomics & Outcomes Research, 8(2), 165–178.
   PubMedGoogle Scholar
• Ho, P.M., Lambert-Kerzner, A., Carey, E.P., Fahdi, I.E., Bryson, C.L., Melnyk, S.D., Bosworth, H.B., Radcliff, T., Davis, R., Mun, H., Weaver, J., Barnett, C., Baron, A. and Del Giacco, E.J. (2014) Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: A randomized clinical trial. JAMA Internal Medicine, 174(2), 186–193.
   PubMed Web of Science ®Google Scholar
• Ho, T.-Y., Fishman, P.A. and Zabinsky, Z.B. (2016) Designing and analyzing healthcare insurance policies to reduce cost and prevent the spread of seasonal influenza, in Proceedings of the 2016 Winter Simulation Conference, pp. 2018–2029. IEEE Press, Piscataway, NJ.
   Google Scholar
• Ibrahim, R., Kucukyazici, B., Verter, V., Gendreau, M. and Blostein, M. (2016) Designing personalized treatment: An application to anticoagulation therapy. Production and Operations Management, 25(5), 902–918.
   Web of Science ®Google Scholar
• Jiang, H., Pang, Z. and Savin, S. (2012) Performance-based contracts for outpatient medical services. Manufacturing & Service Operations Management, 14(4), 654–669.
   Web of Science ®Google Scholar
• Kazemian, P., Helm, J.E., Lavieri, M.S., Stein, J.D. and van Oyen, M.P. (2018) Dynamic monitoring and control of irreversible chronic diseases with application to glaucoma.
   Google Scholar
• Kazi, D.S., Moran, A.E., Coxson, P.G., Penko, J., Ollendorf, D.A., Pearson, S.D., Tice, J.A., Guzman, D. and Bibbins-Domingo, K. (2016) Cost-effectiveness of PCSK9 inhibitor therapy in patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease. Journal of the American Medical Association, 316(7), 743–753.
   Google Scholar
• Khojandi, A., Maillart, L.M., Prokopyev, O.A., Roberts, M.S. and Saba, S.F. (2018) Dynamic abandon/extract decisions for failed cardiac leads. Management Science, 64(2), 633–651.
   Web of Science ®Google Scholar
• Klees, B., Wolfe, C. and Curtis, C. (2010) Brief summaries of medicare and medicaid: Title xviii & Title xix of the Social Security Act as of November 1, 2010. Retrieved 26 May 2011. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/downloads/MedicareMedicaidSummaries2009.pdf.
   Google Scholar
• Koek, H.L., de Bruin, A., Gast, F., Gevers, E., Kardaun, J.W., Reitsma, J.B., Grobbee, D.E. and Bots, M.L. (2006) Short-and long-term prognosis after acute myocardial infarction in men versus women. The American Journal of Cardiology, 98(8), 993–999.
   Web of Science ®Google Scholar
• Kovacevic, R.M. and Pflug, G.C. (2014) Electricity swing option pricing by stochastic bilevel optimization: A survey and new approaches. European Journal of Operational Research, 237(2), 389–403.
   Web of Science ®Google Scholar
• Law, M., Morris, J. and Wald, N. (2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. British Medical Journal, 338, b1665.
   PubMed Web of Science ®Google Scholar
• Lee, D.K. and Zenios, S.A. (2012) An evidence-based incentive system for Medicare’s end-stage renal disease program. Management Science, 58(6), 1092–1105.
   Web of Science ®Google Scholar
• Lee, E., Lavieri, M.S., Volk, M.L. and Xu, Y. (2015) Applying reinforcement learning techniques to detect hepatocellular carcinoma under limited screening capacity. Health Care Management Science, 18(3), 363–375.
   Web of Science ®Google Scholar
• Lee, E., Lavieri, M.S., Volk, M.L. and Xu, Y. (2018) Optimal screening for hepatocellular carcinoma: A restless bandit model. Manufacturing & Service Operations Management. doi:10.1287/msom.2017.0697.
   Google Scholar
• Ma, B. C.-t. A. and Mcguire, T.G. (1997) Optimal health insurance and provider payment. The American Economic Review, 87(4), 685–704.
   Web of Science ®Google Scholar
• Mann, B.S., Barnieh, L., Tang, K., Campbell, D.J., Clement, F., Hemmelgarn, B., Tonelli, M., Lorenzetti, D. and Manns, B.J. (2014) Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: A systematic review. PloS one, 9(3), e89168. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089168.
   PubMed Web of Science ®Google Scholar
• Manning, W.G., Newhouse, J.P., Duan, N., Keeler, E.B. and Leibowitz, A. (1987) Health insurance and the demand for medical care: Evidence from a randomized experiment. The American Economic Review, 77(3), 251–277.
   PubMed Web of Science ®Google Scholar
• Mason, J.E., Denton, B.T., Shah, N.D. and Smith, S. (2014) Optimizing the simultaneous management of blood pressure and cholesterol for type 2 diabetes patients. European Journal of Operational Research, 233(3), 727–738.
   Web of Science ®Google Scholar
• Mason, J.E., England, D.A., Denton, B.T., Smith, S.A., Kurt, M. and Shah, N. D. (2012) Optimizing statin treatment decisions for diabetes patients in the presence of uncertain future adherence. Medical Decision Making, 32(1), 154–166.
   Web of Science ®Google Scholar
• McCain, J. (2016) National Defense Authorization Act for Fiscal Year 2017 Bill number: H.R. 4909. 114th U.S. Congress (2015-2016). https://www.congress.gov/bill/114th-congress/house-bill/4909.
   Google Scholar
• Medicare Payment Advisory Commission and others (2013 ) Report to the Congress: Medicare and the health care delivery system. Washington, DC.
   Google Scholar
• Mehrotra, S. and Kim, K. (2011) Outcome based state budget allocation for diabetes prevention programs using multi-criteria optimization with robust weights. Health Care Management Science, 14(4), 324–337.
   Web of Science ®Google Scholar
• Mills, A.F., Argon, N.T. and Ziya, S. (2013) Resource-based patient prioritization in mass-casualty incidents. Manufacturing & Service Operations Management, 15(3), 361–377.
   Web of Science ®Google Scholar
• Moran, A.E., Odden, M.C., Thanataveerat, A., Tzong, K.Y., Rasmussen, P.W., Guzman, D., Williams, L., Bibbins-Domingo, K., Coxson, P.G. and Goldman, L. (2015) Cost-effectiveness of hypertension therapy according to 2014 guidelines. New England Journal of Medicine, 372(5), 447–455.
   Web of Science ®Google Scholar
• Mussard, S., Seyte, F. and Terraza, M. (2003) Decomposition of GINI and the generalized entropy inequality measures. Economics Bulletin, 4(7), 1–6.
   Google Scholar
• Neumann, P.J., Cohen, J.T. and Weinstein, M.C. (2014) Updating cost-effectiveness the curious resilience of the $50,000-per-QALY threshold. New England Journal of Medicine, 371(9), 796–797.
   PubMed Web of Science ®Google Scholar
• Original Medicare (Part A and B) Eligiblity and Enrollment (n.d.) https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartAB EligEnrol/index.htm. Accessed: 27 February 2018.
   Google Scholar
• Sahney, V.K. and Weddle, T. (1980) A model for sensitivity analysis of reimbursement in hospitals. AIIE Transactions, 12(2), 133–139.
   Google Scholar
• Santschi, V., Chiolero, A., Paradis, G., Colosimo, A.L. and Burnand, B. (2012) Pharmacist interventions to improve cardiovascular disease risk factors in diabetes a systematic review and meta-analysis of randomized controlled trials. Diabetes Care, 35(12), 2706–2717.
   PubMed Web of Science ®Google Scholar
• Schell, G.J. (2015) Personalized medicine in chronic disease management. PhD thesis, University of Michigan, Ann Arbor, MI.
   Google Scholar
• Schell, G.J., Marrero, W.J., Lavieri, M.S., Sussman, J.B. and Hayward, R.A. (2016) Data-driven Markov decision process approximations for personalized hypertension treatment planning. MDM Policy & Practice, 1(1), 238146831667421. doi:10.1177/2381468316674214.
   Google Scholar
• Schottmüller, C. (2013) Cost incentives for doctors: A double-edged sword. European Economic Review, 61, 43–58.
   Web of Science ®Google Scholar
• Shechter, S.M., Bailey, M.D., Schaefer, A.J. and Roberts, M.S. (2008) The optimal time to initiate HIV therapy under ordered health states. Operations Research, 56(1), 20–33.
   Web of Science ®Google Scholar
• Skandari, M.R., Shechter, S.M. and Zalunardo, N. (2015) Optimal vascular access choice for patients on hemodialysis. Manufacturing & Service Operations Management, 17(4), 608–619.
   Google Scholar
• Sussman, J., Vijan, S. and Hayward, R. (2013) Using benefit-based tailored treatment to improve the use of antihypertensive medications. Circulation, 128(21), 2309–2317.
   Web of Science ®Google Scholar
• Sussman, J.B., Vijan, S., Choi, H. and Hayward, R.A. (2011) Individual and population benefits of daily aspirin therapy: A proposal for personalizing national guidelines. Circulation: Cardiovascular Quality and Outcomes, 4(3), 268–275.
   PubMed Web of Science ®Google Scholar
• Tamblyn, R., Reidel, K., Huang, A., Taylor, L., Winslade, N., Bartlett, G., Grad, R., Jacques, A., Dawes, M., Larochelle, P. and Pinsonneault, A. (2010) Increasing the detection and response to adherence problems with cardiovascular medication in primary care through computerized drug management systems: A randomized controlled trial. Medical Decision Making, 30(2), 176–188.
   PubMed Web of Science ®Google Scholar
• Timbie, J.W., Hayward, R.A. and Vijan, S. (2010) Variation in the net benefit of aggressive cardiovascular risk factor control across the US population of patients with diabetes mellitus. Archives of Internal Medicine, 170(12), 1037–1044.
   PubMedGoogle Scholar
• Weinstein, M.C., Coxson, P.G., Williams, L.W., Pass, T.M., Stason, W.B. and Goldman, L. (1987) Forecasting coronary heart disease incidence, mortality, and cost: The coronary heart disease policy model. American Journal of Public Health, 77(11), 1417–1426.
   PubMed Web of Science ®Google Scholar
• Yaesoubi, R. and Roberts, S.D. (2011) Payment contracts in a preventive health care system: A perspective from operations management. Journal of Health Economics, 30(6), 1188–1196.
   Web of Science ®Google Scholar
• Zaric, G.S., Zhang, H. and Mahjoub, R. (2013) Modeling risk sharing agreements and patient access schemes, in Operations Research and Health Care Policy, Springer, New York, NY. pp.295–310.
   Google Scholar
• Zepeda, E.D. and Sinha, K.K. (2016) Toward an effective design of behavioral health care delivery: An empirical analysis of care for depression. Production and Operations Management, 25(5), 952–967.
   Web of Science ®Google Scholar
• Zhang, J., Denton, B.T., Balasubramanian, H., Shah, N.D. and Inman, B.A. (2012a) Optimization of prostate biopsy referral decisions. Manufacturing & Service Operations Management, 14(4), 529–547.
   Google Scholar
• Zhang, J., Denton, B.T., Balasubramanian, H., Shah, N.D. and Inman, B.A. (2012b) Optimization of PSA screening policies. Medical Decision Making, 32(2), 337–349.
   PubMed Web of Science ®Google Scholar
• Zhang, Y., Berman, O., Marcotte, P. and Verter, V. (2010) A bilevel model for preventive healthcare facility network design with congestion. IIE Transactions, 42(12), 865–880.
   Web of Science ®Google Scholar