COMPETITION AND HEALTH PLAN PREMIUM DETERMINATION

竞争和健康计划保费确定

• 批准号: 2236539
• 负责人: RANDALL P. ELLIS
• 金额: $ 7.85万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-08-01 至 1996-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2236539
• 关键词: Medicare /Medicaid; health care cost /financing; health care model; health care service planning; health insurance; managed care; mathematical model; patient care planning; statistics /biometry

This project will examine how competition influences the determination of health plan premiums. Currently, health plan premiums are set in a variety of ways: community rating, experience rating, competitive bidding, negotiated rate setting, and government formulas. Premiums are also influenced by factors such as whether the employer pays a fixed amount or a fixed proportion toward each plan, the number of plans offered, exit and entry of health plans, and the market share of HMOs. This project will attempt to identify the rate setting mechanisms and market structures where competition seems to work well. The specific aims of the project are to answer the following questions: (1) Do employers offering a large number of health plans experience lower or higher premiums and rates of premium growth than employers offering fewer health plans? (2) Do employers with high proportion of their employees in HMOs and PPO enrollment have lower or higher premiums and rates of premium growth than employers with low proportion of such enrollment? (3) Do market areas with high proportion of HMO and PPO enrollment have lower or higher premiums and rates of premium growth than region with low proportion of HMO and PPO enrollment? (4) What is the empirical evidence concerning the importance of having the employer pay a fixed amount toward each plan versus a fixed proportion of each plan? (5) What characteristics of state and private employer negotiations over and bidding for premiums have resulted in the lowest levels and slowest rates of growth of health premiums? (6) What market structures and health plan characteristics have been most closely associated with biased selection and premium "death spirals?" (7) What is the empirical evidence about pricing strategies of health plans? (8) How does the number of health plans competing for a single group of employees affect the outcome? (9) What are the patterns of market exit and entry by health plans? These questions will be answered using primarily empirical analysis. The characteristics of health plans, employers, and health care market structures will be related to health care premium levels and rates of growth of health plan premiums. The analysis will have three parts. First, a meta-analysis of studies of biased selection literature will be conducted. Second, state employee health plans will be surveyed and the premium and enrollment data used for multivariate statistical analysis. Third, HMO enrollments by county will be related to premium data collected from the state employers and used to assess how the HMO market characteristics affect the setting of premiums for state employees.

这个项目将研究竞争如何影响决定 健康计划保费。目前，健康计划保费是在一个 多种方式：社区评级，经验评级，竞争力 投标、协议费率设定和政府公式。保费 还受到雇主是否支付固定工资等因素的影响。 金额或固定比例对每个计划，计划的数量 提供，退出和健康计划的进入，以及HMO的市场份额。 本项目将试图确定费率确定机制， 市场结构中的竞争似乎运作良好。 该项目的具体目标是回答以下问题： (1)雇主提供大量的健康计划的经验较低 或高于雇主提供的保费和保费增长率 更少的健康计划？(2)雇主是否有高比例的 HMO和PPO登记的员工有更低或更高的保费， 保费增长率比用人单位低等比例 招生？(3)做HMO和PPO比例高的市场区域 投保的保费和保费增长率低于或高于 HMO和PPO入学比例低的地区？(4)是什么 关于雇主支付的重要性的经验证据 每个计划的固定金额还是每个计划的固定比例？ (5)国家和私人雇主谈判的特点是什么？ 和竞标保费导致了最低水平和最慢的 健康保险费的增长率？(6)什么样的市场结构和健康 计划特征与偏见最密切相关， 选择和溢价“死亡螺旋？which is the most important cause of the disease.“ 健康计划的定价策略(8)数量如何 为一组员工竞争的健康计划会影响 结果如何？(9)按健康退出和进入市场的模式是什么 计划？ 这些问题将主要通过实证分析来回答。的 健康计划、雇主和医疗保健市场的特点 结构将与医疗保险费水平和费率有关， 健康计划保费的增长。分析将分为三个部分。 首先，将对偏倚选择文献的研究进行荟萃分析， 进行。其次，将对州雇员健康计划进行调查， 保费和入组数据用于多变量统计分析。 第三，按县划分的HMO注册将与保费数据相关 从州雇主那里收集的数据，用于评估HMO市场 这些特点影响到国家雇员保险费的确定。