Health Economics (Credit Hours: 3)

Transcription

1 HPM 315 Health Economics (Credit Hours: 3) Department of Health Policy and Management Gillings School of Global Public Health Syllabus McGavran-Greenberg Room 2308 Tu/Th 11:00 am 12:15 pm Instructor: Justin Trogdon TA: Office: 1101-B McGavran-Greenberg Hall Location: Phone: (919) Office hours: Wednesdays 3-4 pm and by appointment Office Hours: Juan Carlos Salgado Hernandez 1106-G McGavran-Greenberg Hall Mondays 1-2 pm and by appointment Course Overview This course will provide students economic tools and perspectives that will be applied to the market for health and health care. We will apply key concepts such as opportunity cost and incentives to individual behavior (consumer demand) and firm behavior (supply). Then, we will study how these actors (consumers, providers, hospital, and insurers) interact to yield market outcomes (prices and quantities). We will then evaluate these market outcomes in terms of efficiency and equity and identify market failures that could be addressed with public policy. Economics provides a unique way of approaching difficult policy decisions in the health care and public health systems. The goal is to give students the knowledge and experience to analyze health policy and management issues using economic concepts and tools. While we will draw on other fields such as health services research, public health, and clinical medicine, the thrust of this course is economic. The course will not use calculus, but students should be comfortable with mathematical functions, algebra, and graphical analysis. Prerequisite: ECON 101 Introduction to Economics. This course will go deeper into the decisions generating demand and supply and the resulting market outcomes. We will apply these concepts to the market for health and health care, including current issues, throughout the course. HPM Justin Trogdon

2 Learning Objectives and HPM Competencies Course Learning Objective By the time students finish this course, they should be able to 1. Define microeconomic terms used for policy analysis in health care markets 2. Describe key assumptions and features of the microeconomic approach to health and health care 3. Explain the unique features of the market for health and health care relative to perfectly competitive markets 4. Constructively and critically analyze issues in health care and public health using economic tools 5. Assess the potential impact of hypothetical interventions in the health care system on outcomes (cost, quality, and access) and on participants (consumers, providers, and insurers) HPM Competencies Through this course, students will further develop the following knowledge, skills, and abilities Research, Analysis & Problem Solving Skills Research, Analysis & Problem Solving Skills Health Industry Knowledge Research, Analysis & Problem Solving Skills Research, Analysis & Problem Solving Skills Communication and Teamwork Skills Research, Analysis & Problem Solving Skills Resources Website HPM 315 has its own website using Sakai software: This will be the primary resource for course-related communication. Course materials including this syllabus, Power Point presentations, assignments, optional readings, and announcements will be posted periodically. Students should check the website regularly. Required Text Folland S, Goodman AC and Stano M. The Economics of Health and Health Care, Eighth Edition, Upper Saddle River, New Jersey: Pearson Prentice Hall, Optional Texts McAfee P and Lewis T. Introduction to Economic Analysis, Second Edition. This is an open-source intermediate microeconomic text available for free here: It relies heavily on mathematical models, including calculus, but provides a solid treatment of the building blocks of economic analysis. Pinkyck and Rubinfeld. Microeconomics. On reserve Nicholson. Intermediate microeconomics and its application. On reserve HPM Justin Trogdon

3 Articles Supplemental readings have been compiled and are available from the UNC library system. Relevant readings will be identified under specific topics throughout the course. Web Sources We will be following an excellent health economics/health policy blog: The Incidental Economist by Austin Frakt and others ( Students will discuss and comment on recent postings periodically as part of their class participation assessment (see below). The internet provides a vast amount of resources for health economics. A good place to start is Resources for Economists on the Internet (sponsored by the American Economic Association): Review of these websites and links is not required. Requirements and Expectations Class Participation (5%) Quizzes Each class will begin with a short, three-question quiz (10 min). The quiz will cover the readings assigned for that class session. Your lowest score from the semester will be dropped. Reading questions In advance of each session with new reading assigned, students will post one question to the Sakai Forum based on the readings for that day. Questions can request clarification about a topic or spark insightful discussions during the sessions. Questions should not repeat other questions in the Forum. The instructor will use some of the students questions to structure the discussions. Questions are due the day of each session with new reading assigned by 9am. Problem Sets (20%) Problem sets will be assigned most weeks. Submission requirements will be noted on each problem set. All assignments are due by the beginning of class on the due date unless otherwise noted. Late problem sets will NOT be accepted. Grades on the problem sets will be A (all problems correct), B (all problems attempted and answers mostly correct), C (incomplete or contain substantial errors), or F (not turned in on time). Your lowest score from the semester will be dropped. I encourage you to work together on homework; however, everyone must submit their own solutions to the problem sets in their own words. An identical homework solution from two or more students is an indication of cheating. Graded Team Discussion Question (10%) There will be a team discussion question that will be presented during the class sessions. The instructor will assign students to teams. Typically, each student will read the assignment and complete any individual requirements and then the team will discuss the assignment via or breakout room. During class, the team will present their results/findings. Each presentation is expected to last HPM Justin Trogdon

4 minutes to be followed by discussion by the larger class. A grading rubric providing the evaluation criteria will be provided prior to the assignment. The schedule for presentation can be found in the course schedule below. Each team will receive one grade for the presentation. Students will assess the contributions that team members made to team performance. Prior to the last day of class, each student will be asked to evaluate his or her teammates in four dimensions: preparation, participation and communication, helps group excel, and cooperation. Students will rank teammates in each dimension using a four-point scale: usually (over 90% of the time), frequently (more often than not), sometimes (less than half the time), and rarely (never or once in a great while). Ratings for each team member will be summed and expressed as a percentage of total possible points (16 = 4x4). The median rating by team members will be the student s peer assessment grade. The grade for the team discussion question = 80%*(team presentation grade) + 20%*(peer assessment grade). Exams (65%) There will be three exams: two midterm exams and one final exam. The lower of your two mid-term exams will be dropped. Missed exams Missed exams can be made up only in cases of extreme circumstances (e.g., death in the family, serious illness) or travel related to University activities. An official excuse from campus health, team coach or other University official is required for any missed exams. If you know you will miss an exam, you must notify the instructor at least one week in advance and make arrangements to take the exam prior to the scheduled exam time. Any student taking an exam early may not disclose any information related to the exam or the topics covered. Any communication with other students regarding the exam is a violation of the Honor Code of the University of North Carolina. Evaluation / Grading % of Component Grade Class participation 5 Graded team discussion question 10 Problem sets 20 Max{Midterm 1, Midterm 2} 30 Final exam 35 Grading Scale 94 to 100 (A) 90 to 93 (A-) 87 to 89 (B+) 84 to 86 (B) 80 to 83 (B-) 77 to 79 (C+) HPM Justin Trogdon

5 74 to 76 (C) 70 to 73 (C-) 67 to 69 (D+) 60 to 66 (D) Below 60 (F) Guidelines on Use of Laptops and Other Electronics in Classroom Turn off cell phones in class and during exams. Laptops may be used in class only for taking notes and for looking up information relevant to the topic being discussed. Recognizing, Valuing, and Encouraging Diversity The importance of diversity is recognized in the mission statement of HPM. In the classroom, diversity strengthens the products, enriches the learning, and broadens the perspectives of all in the class. Diversity requires an atmosphere of inclusion and tolerance, which oftentimes challenges our own closely-held ideas, as well as our personal comfort zones. The results, however, create a sense of community and promote excellence in the learning environment. This class will follow principles of inclusion, respect, tolerance, and acceptance that support the values of diversity. Diversity includes consideration of: (1) life experiences, including type, variety, uniqueness, duration, personal values, political viewpoints, and intensity; and (2) factors related to diversity of presence, including, among others, age, economic circumstances, ethnic identification, family educational attainment, disability, gender, geographic origin, maturity, race, religion, sexual orientation, social position, and veteran status. UNC Office of Accessibility Resources & Services (ARS) UNC-CH supports all reasonable accommodations, including resources and services, for students with disabilities, chronic medical conditions, a temporary disability, or a pregnancy complication resulting in difficulties with accessing learning opportunities. All accommodations are coordinated through the UNC Office of Accessibility Resources & Services (ARS), phone , accessibility@unc.edu. Students must document/register their need for accommodations with ARS before accommodations can be implemented. UNC Honor Code The principles of academic honesty, integrity, and responsible citizenship govern the performance of all academic work and student conduct at the University as they have during the long life of this institution. Your acceptance of enrollment in the University presupposes a commitment to the principles embodied in the Code of Student Conduct and a respect for this most significant Carolina tradition. Your reward is in the practice of these principles. Your participation in this course comes with the expectation that your work will be completed in full observance of the Honor Code. Academic dishonesty in any form is unacceptable, because any breach in academic integrity, however small, strikes destructively at the University's life and work. HPM Justin Trogdon

6 If you have any questions about your responsibility or the responsibility of faculty members under the Honor Code, please consult with someone in either the Office of the Student Attorney General ( ) or the Office of the Dean of Students ( ). Read The Instrument of Student Judicial Governance ( Course Evaluation HPM participates in the UNC-CH s online course evaluation system, enabled at the end of each semester. Your responses will be anonymous, with feedback provided in the aggregate. Open-ended comments will be shared with instructors, but not identified with individual students. Your participation in course evaluation is an expectation, since providing constructive feedback is a professional obligation. Feedback is critical, moreover, to improving the quality of our courses, as well as for instructor assessment. Course Schedule The course schedule is subject to change. Check the course website on Sakai for the most recent version. MODULE I: CONSUMER CHOICE AND DEMAND Session 1.1 Aug 22 Course Introduction, Course Overview, and Brief Discussion of U.S. Health Care Market Session 1.2 Aug 24 & 29 This session provides an overview of course content and describes how the course is structured and operates. The discussion of U.S. health care market helps put the course content in context. Know what the course will cover Know how the course is structured, including its website, readings, problem sets, exams, case and group presentation Know what is expected of students NOT APPLICABLE Folland et al. Chapter 1 Introduction ; Morrisey and Cawley (2008); Fuchs (2015) NONE Utility and Choice This session presents the economic model of consumer choice, in which consumers maximize their satisfaction subject to a budget constraint. Describe how economists model consumer choice Understand how resources limits choice Use diagrams to show consumer choice over two goods HPM Justin Trogdon

7 Indifference curve Marginal rate of substitution (MRS) Perfect substitutes and complements Utility Budget constraint Marginal benefit and marginal cost Folland et al. Chapter 2, pp : Scarcity and the Production Possibilities Frontier - Consumer Equilibrium * McAfee & Lewis, Chapter 12, Sections 1-4; P&R Chapter 3. Complete Math Self-test (do not turn in); Work on problem set 1 Session 1.3 Aug 31 Individual Demand Curves This session discusses translating the model of consumer choice to individual demand curves and the properties of those curves for different kinds of goods. Translate the consumer choice problem (using preferences and budget constraints) to individual demand curves Analyze how changes in prices and income affect consumer choice Individual demand curve Normal vs. inferior goods Income and substitution effects Giffen good Folland et al. Chapter 2, p. 42: Individual and Market Demands * McAfee & Lewis, Chapter 12, Sections 5 and 6; P&R Chapter 4, Sections 1 and 2. Problem set 1 due Session 1.4 Sep 5 Market Demand and Elasticity This session discusses demand aggregated across all consumers in a market and how to measure the benefits of trade to consumers. Define elastic, inelastic, and unit elastic Predict the expected change in quantity demanded given a change in price using elasticity of demand Market demand curve Elasticity Consumer surplus Folland et al. Chapter 2, p : Elasticities * P&R Chapter 4, Sections 3 and 4 Work on problem set 2 Session 1.5 Sep 5 & 12 Why is Health Economics Special? HPM Justin Trogdon

8 This session provides an application of the consumer choice model to health and health care, including discussion of two additional demand shifters: time and coinsurance. List several unique features of health and health care as goods for consumer demand Explain how the RAND Health Insurance Study estimated demand elasticities for health care Time price Coinsurance Estimates of price elasticities Folland et al. Chapter 9 Consumer Choice and Demand ; Newhouse and Sinaiko (2008) Work on problem set 2 Group 1 presents Discussion Question Session 1.6 Sep 14 Imperfect Information and the Demand for Health Care This session provides a discussion of imperfect information and its effect on the demand for health and health care services. Describe the role of physician as a patient s agent Compare and contrast consumer s perception of quality for medical services to other goods Principal agent Imperfect information Folland et al. Chapter 10, pp : The Agency Relationship - Summary * McAfee & Lewis, Chapter 18 and Chapter 19, Sections 1 and 2; P&R Chapter 17, Section 4 Problem set 2 due Group 2 presents Discussion Question Study for midterm 1 Sep 19 Midterm Exam 1 Exams require students to demonstrate basic knowledge and comprehension, to apply concepts to specific problems, and to analyze how different concepts apply to real-world situations. NOT APPLICABLE NOT APPLICABLE NONE NONE HPM Justin Trogdon

9 Comments: Exams are in-class, closed book, and may consist of multiple choice, truefalse, short answer, problems, and brief essay questions. Exams cover material from required readings, lectures, problem sets, in-class exercises, and in-class discussions. The first mid-term covers Module 1 Consumer Choice and Demand. MODULE II: HEALTH INSURANCE Session 2.1 Sep 21 & 26 Uncertainty This session discusses consumer choice under uncertainty. Set up the consumer s problem with uncertain outcomes Describe the relationship between risk aversion and the demand for insurance Expected value Marginal utility of wealth Risk aversion Risk premium Folland et al. Chapter 8, pp : What is Insurance - Purchasing Insurance * McAfee & Lewis, Chapter 13, Section 4 Risk Aversion; P&R Chapter 5, Sections 1 and 2. Work on problem set 3 Session 2.2 Sep 28 Demand for Health Insurance This session extends the discussion of choice under uncertainty to the demand for insurance. Describe the key features of an insurance policy Analyze the change in the demand for insurance accompanying changes in the premium, expected losses, and wealth Premium Coinsurance/copayment Deductible Folland et al. Chapter 8, pp : The Demand for Insurance - Changes in Weatlh *P&R Chapter 5, Section 3 Work on problem set 3 Session 2.3 Oct 3 & 5 Supply of Health Insurance HPM Justin Trogdon

10 This session discusses the supply of health insurance, efficient levels of insurance, and the implied income transfers from insurance. Explain how insurance leads to moral hazard and how moral hazard varies with features of the insurance policy Describe the optimal level of insurance Compare and contrast the welfare gains and losses from insurance Moral hazard Folland et al. Chapter 8, pp : The Supply of Insurance - Summary ; Pauly (2008) on moral hazard * P&R Chapter 17, Section 3 Problem set 3 due Group 3 presents Discussion Question Session 2.4 Oct 10 Health Insurance Markets This session discusses health insurance markets, including situations where health insurance markets unravel and the indirect effects of employerprovided health insurance. Explain the causes and consequences of adverse selection Analyze the effects of employer-provided health insurance on the demand for health insurance and the labor market Adverse selection Lemons principle Loading costs Compensating differentials Folland et al. Chapter 10, pp : Overview of Information Issues - Experience Rating and Adverse Selection ; Chapter 11; Pauly (2008) on adverse selection; French et al. (2016) * P&R Chapter 17, Section 1 Problem set 4 due Oct 12 Session 2.5 Oct 17 & 24 UNIVERSITY DAY No classes held Health Insurance Markets Managed Care This session focuses on managed care, a hybrid insurance/provision solution to some of the information problems of traditional health insurance, and managed care-like reforms in the Affordable Care Act. Compare and contrast managed care with fee-for-service in theory and in practice HPM Justin Trogdon

11 Oct 19 Types of insurance providers: fee-for-service (FFS), preferred provider organization (PPO), point-of-service (POS), and health maintenance organization (HMO) Dumping/creaming/skimming Explain the key provisions of the ACA Folland et al. Chapters 12 and 22: Chapter 12 Managed Care ; Chapter 22 Health System Reform ; Blumenthal et al. (2015); Obama (2016); Skinner and Chandra (2016) Group 4 presents Discussion Question Problem set 5 due FALL BREAK No classes held Oct 26 Midterm Exam 2 Comments: MODULE III: Exams require students to demonstrate basic knowledge and comprehension, to apply concepts to specific problems, and to analyze how different concepts apply to real-world situations. NOT APPLICABLE NOT APPLICABLE NONE NONE Exams are in-class, closed book, and may consist of multiple choice, truefalse, short answer, problems, and brief essay questions. Exams cover material from required readings, lectures, problem sets, in-class exercises, and in-class discussions. The second mid-term covers Module 2 Health Insurance. PRODUCTION, COSTS, AND SUPPLY Session 3.1 Oct31 Production This session discusses how firms convert inputs into outputs in an optimal manner. Describe how economists model production Understand how technology limits production Use diagrams to show production using two inputs/factors HPM Justin Trogdon

12 Factors of production Production function Short run vs. long run Average product Marginal product Law of diminishing marginal returns Isoquant Marginal rate of technical substitution Returns to scale Folland et al. Chapter 2, pp : Production and Market Supply - Isocost Curves * McAfee & Lewis, Chapter 9, Sections 1 & 2. P&R Chapter 6 (e.g., Example 6.1) Group 5 presents Discussion Question Work on problem set 6 Session 3.2 Nov 2 Costs This session provides an in-depth discussion of a firm s costs of production. Differentiate the various ways costs are measured Connect different cost measures to key decisions of the firm (e.g., production levels, shutdown) Economic vs. accounting cost Opportunity cost Total cost Fixed cost Variable cost Marginal cost Average (total, fixed, or variable) cost Economies of scale and scope Folland et al. Chapter 2, pp. 49: Cost Minimization or Output Maximization - Marginal and Average Cost Curves * McAfee & Lewis, Chapter 9, Section 6. P&R Chapter 7 Work on problem set 6 Group 6 presents Discussion Question Session 3.3 Nov 7 Profit Maximization and Competitive Supply This session discusses how profit-maximizing firms determine their level of supply to the market. Define the optimal level of production Distinguish between profit maximizing output in the short run and the long run Perfect competition Profit Marginal revenue Producer surplus HPM Justin Trogdon

13 Folland et al. Chapter 2, pp : The Firm Supply Curve under Perfect Competition * McAfee & Lewis, Chapter 10. P&R Chapter 8. Work on problem set 6 Group 7 presents Discussion Question Session 3.4 Nov 9 Nonprofit Firms This session discusses alternative goals of firms besides profit, their role in the health care system, and key differences for policy analysis. List several reasons why nonprofits exist in health care Describe economic models of nonprofit firm behavior Compare and contrast the actual behavior of nonprofit and for-profit hospitals Quantity-Quality theory Physician s cooperative theory Folland et al. Chapter 13 Nonprofit Firms ; Eggleston et al. (2008); Gaynor et al. (2015) Section Problem set 6 due Session 3.5 Nov 14 Hospitals and Long-Term Care This session discusses hospitals and nursing homes as key producers of health care services. Describe recent trends in hospital markets Analyze how changes in reimbursement rates affect hospitals and longterm care facilities production and profitability Cost-shifting Medical arms race Folland et al. Chapter 14 Hospitals and Long-Term Care ; Gaynor et al. (2015) Sections and 4 Work on problem set 7 Group 8 presents Discussion Question Session 3.6 Nov 16 Physicians This session discusses physicians as key producers of health care services. Explain the theory of supplier-induced demand and summarize the empirical evidence for or against the theory Describe the welfare consequences of small area variations in practice patterns and evaluate the empirical evidence Supplier-induced demand Small area variations Folland et al. Chapter 15 The Physician s Practice ; Gaynor et al. (2015) Section 3.2 HPM Justin Trogdon

14 Work on problem set 7 MODULE IV: MARKET EQUILIBRIA Session 4.1 Nov 21 & 28 Perfect Competition and Efficiency This session provides a discussion of perfectly competitive markets. Define the concept of Pareto efficiency and how perfectly competitive markets achieve it Use Edgeworth boxes to show the effect of different endowments on competitive equilibria List the assumptions of perfectly competitive markets and ways in which health care markets may violate these assumptions Edgeworth box Pareto efficiency (optimality) Contract curve First Fundamental Theorem of Welfare Economics Second Fundamental Theorem of Welfare Economics Theorem of the Second Best Folland et al. Chapter 18, pp : Efficiency and Competitive Markets - The Theorem of the Second Best * McAfee & Lewis, Chapter 14, Sections 1 and 2; P&R Chapter 9, Sections 1 and 2; P&R Chapter 16, Sections 2, 3, 6 and 7 (e.g., Example 16.5) Work on problem set 7 Group 9 presents Discussion Question Nov 23 THANKSGIVING BREAK No classes held Session 4.2 Nov 30 Economic Efficiency and Cost-Benefit Analysis This session will review economic efficiency and cover cost-benefit analysis, an important tool for evaluating the value of new technologies or interventions. Explain how to interpret cost-benefit/cost-effectiveness ratios Compare and contrast cost-benefit vs. cost-effectiveness analyses Compare and contrast QALYs vs. DALYs HPM Justin Trogdon

15 Cost-benefit analysis Opportunity cost Discounting Willingness to pay Willingness to accept Cost-effectiveness analysis Quality-adjusted life-years Disability-adjusted life-years Folland et al. Chapter 4 Economic Efficiency and Cost-Benefit Analysis Work on problem set 7 Session 4.3 Dec 5 Market Power and the Pharmaceutical Industry This session provides a discussion of non-competitive markets using the pharmaceutical industry as an example. Explain the rationale for drug patents and the effects for producers and consumers Use production theory to describe substitution between drugs and other medical and non-medical health inputs Analyze alternative policies to contain prescription drug costs Market power Deadweight loss Barriers to entry Monopoly pricing Price discrimination Folland et al. Chapter 17 The Pharmaceutical Industry ; Grabowski et al. (2011) * McAfee & Lewis, Chapter 15, Sections 1-6. P&R Chapter 10, Sections 1 through 4 (e.g., Example 10.1) Problem set 7 due Group 10 presents Discussion Question The final exam will be held on Thursday, December 14 th at 12:00pm. This is the university final exam schedule and cannot be changed. The final exam is comprehensive but will be more heavily weighted toward material covered after the second midterm. The location of the exam will be announced once it is determined. Summary of Significant Dates: Tuesday, September 5 th Tuesday, September 5 th Problem Set 1 due at beginning of class Group 1 presents discussion question Thursday, September 7 th CHANGED meeting time to Sep. 5 at 9:30a Thursday, September 14 th Problem Set 2 due at beginning of class HPM Justin Trogdon

16 Thursday, September 14 th Tuesday, September 19 th Tuesday, October 3 rd Thursday, October 5 th Tuesday, October 10 th Thursday, October 12 th Thursday, October 19 th Thursday, October 24 th Tuesday, October 24 th Tuesday, October 26 th Thursday, October 31 st Tuesday, November 2 nd Tuesday, November 7 th Tuesday, November 9 th Thursday, November 14 th Thursday, November 21 st Thursday, November 23 rd Thursday, December 5 th Thursday, December 5 th Thursday, December 14 th Group 2 presents discussion question MIDTERM 1, in class Problem Set 3 due at beginning of class Group 3 presents discussion question Problem Set 4 due at beginning of class University Day NO CLASS Fall break NO CLASS Group 4 presents discussion question Problem Set 5 due at beginning of class MIDTERM 2, in class Group 5 presents discussion question Group 6 presents discussion question Group 7 presents discussion question Problem Set 6 due at beginning of class Group 8 presents discussion question Group 9 presents discussion question Thanksgiving holiday NO CLASS Group 10 presents discussion question Problem Set 7 due at beginning of class FINAL EXAM, 12:00 3:00 p.m. Readings Blumenthal, D. et al. (2015). The Affordable Care Act at 5 Years. NEJM 372(25): Eggleston, K., et al. (2008). "Hospital Ownership and Quality of Care: What Explain's the Different Results in the Literature?" Health Economics 17(12): French, M. et al. (2016). Key Provisions of the Patient Protection and Affordable Care Act (ACA): A Systematic Review and Presentation of Early Research Findings. Health Services Research epub ahead of print, doi: / Fuchs, V.R. (2015). Major Concepts of Health Care Economics. Annals of Internal Medicine 162: Gaynor, M., K. Ho, and R.J. Town (2015). The Industrial Organization of Health-Care Markets. Journal of Economic Literature 53(2): Garber, A. A. and J. Skinner (2008). "Is American Health Care Uniquely Inefficient?" Journal of Economic Perspectives 22(4): HPM Justin Trogdon

17 Grabowski, H. et al. (2011). "Evolving Brand-Name And Generic Drug Competition May Warrant A Revision Of The Hatch-Waxman Act." Health Affairs 30(11): Morrisey, M. A. and J. Cawley (2008). "Health economists' views of health policy." Journal of Health Politics Policy and Law 33(4): Newhouse, J. P. and A. D. Sinaiko (2008). "What We Know and Don't Know about the Effects of Cost Sharing on the Demand for Medical Care-and So What?" Incentives and Choice in Health Care: Obama, B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA 316(5): Pauly, M. V. (2008). "Adverse Selection and Moral Hazard: Implications for Health Insurance Markets." Incentives and Choice in Health Care: Skinner, J. and A. Chandra (2016). The Past and Future of the Affordable Care Act. JAMA 316(5): HPM Justin Trogdon