COMPETITION AND HEALTH PLAN PREMIUM DETERMINATION

竞争和健康计划保费确定

• 批准号: 2236540
• 负责人: RANDALL P. ELLIS
• 金额: $ 7.62万
• 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 1996-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2236540
• 关键词: COMPETITION; HEALTH; PLAN; PREMIUM; DETERMINATION

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.

这个项目将考察竞争是如何影响决心的 健康计划保费的比例。目前，健康计划保费是按 多种方式：社区评级、体验评级、竞争力 投标、协商的费率设定和政府公式。保费是 也受雇主是否支付固定工资等因素的影响 每个计划的数额或固定的比例，计划的数量 健康计划的提供、退出和进入，以及保健组织的市场份额。 该项目将尝试确定费率设定机制和 竞争似乎运作良好的市场结构。 该项目的具体目标是回答以下问题： (1)提供大量健康计划的雇主是否体验较低 或保费和保费增长率高于雇主提供的 更少的健康计划？(2)高比例的雇主 HMO和PPO投保的员工保费较低或较高，并且 保费增长率高于此类比例较低的雇主 投保？(3)HMO和PPO比例高的市场地区 投保的保费和保费增长率低于或高于 HMO和PPO投保率低的地区？(4)什么是 关于雇主支付工资重要性的经验证据 每个计划的固定金额与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 对保费的竞标导致了最低的水平和最慢的 健康保费的增长率？(6)什么市场结构和健康 计划特征与偏见的关系最为密切 精选和高级“死亡螺旋？”(7)经验证据是什么？ 关于健康计划的定价策略？(8)人数如何 竞争一组员工的健康计划会影响 结果？(9)按健康状况划分的市场退出和进入模式是什么 有什么计划？ 这些问题将主要通过实证分析来回答。这个 健康计划、雇主和医疗保健市场的特点 结构将与医疗保费水平和费率有关 健康计划保费的增长。分析将分为三个部分。 首先，对有偏见的选择文献的研究进行元分析 指挥。其次，将对州雇员健康计划进行调查，并 用于多变量统计分析的保费和投保数据。 第三，各县的HMO投保人数将与保费数据相关 从州雇主那里收集的，用来评估HMO市场 特征影响国家雇员保费的设定。