COSTS AND CHARACTERISTICS OF HEALTH INSURANCE PLANS

在1980至1988年间，美国的医疗保健费用超过 翻了一番，从大约2500亿美元增加到5400亿美元多一点。 这一数字从9.1%增加到11.1% 国民生产总值(国家成本概算办公室， 1990年)。雇主，他们支付医疗保健的主要份额 美国通过与就业相关的铰链福利，是 越来越多地转向自我保险，更多地依赖于 管理的医疗替代方案，如健康维护组织 (HMOS)和首选提供者组织(PPO)在尝试 以控制这些成本。尽管有这些和其他成本 遏制措施，预计国家的医疗保健成本 继续高歌猛进。 HMO经历了整个20世纪80年代的快速增长，但 随着更多样化的模式的创建，增长已经放缓 结合了传统按服务收费的元素的托管凸轮 (FFS)和预付费模式。在HMO快速增长的时期， 大量的研究致力于比较 保健品的选择和费用到FFS保险。尽管有很多研究 仍需在预付费计划上完成，因此研究 选择和成本因素与不同形式的 按经验收费的服务保险。 我们建议使用数据在雇主层面上研究FFS保险 来自健康保险计划调查(船)，赞助 由卫生保健筹资管理局(HCFA)提供。1989年的那艘船 是一项针对雇主的全国性调查，收集了详细的、 计划特定信息。尽管我们的分析将包括 卫生保健组织，我们将专注于按服务收费计划。具体目标 这项研究的目的是回答以下研究问题： 1.哪些因素决定了谁提供医疗保险以及谁提供医疗保险 不? 2.在提供保险的雇主中，哪些因素 确定谁提供HMO或PPO？ 3.在那些提供按服务收费计划的公司中，哪些因素 解释自我保险的决定？ 4.受访者是否将自己的保险计划归类为 他们面临的风险的基础或谁管理的基础 计划是什么？ 5.什么计划和组织特征可以解释差异 在每个订户的医疗保险成本中？ 我们的结果将为我们提供新的见解，了解 医疗保健成本，并将帮助政策制定者评估影响 关于控制成本的新的立法倡议。

Between 1980 and 1988, the nation's health care costs more than doubled, from approximately $250 billion to just over $540 billion. This amount represents an increase from 9.1 percent to 11.1 percent of the gross national product (Office of National Cost Estimates, 1990). Employers, who pay for the major share of health care in the United States through employment-related hinge benefits, are increasingly turning to self-insurance and relying more heavily on managed care alternatives such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) in an attempt to contain these costs. In spite of these and other cost containment measures, the nation's health care costs am expected to continue to soar. HMO experienced rapid growth through the 1980s, but the rate of growth has slowed with the creation of more diverse models of managed cam that combine elements of traditional fee-for-service (FFS) and prepaid models. During the period of rapid HMO growth, a substantial amount of research was devoted to comparing the choice and cost of HMOs to FFS insurance. Although much research remains to be done on prepaid plans, it is important to study the choice and cost factors associated with different forms of experience-rated, fee-for-service insurance. We propose to study FFS insurance at the employer level using data from the 1989 Survey of Health Insurance Plans (SHIP), sponsored by the Health Care Financing Administration (HCFA). The 1989 SHIP was a nationwide survey of employers that gathered detailed, plan-specific information. Although our analyses will include HMOs, we will focus on fee-for-service plans. The specific aims of the research are to answer the following research questions: 1 . What factors determine who offers health insurance and who does not? 2. Among those employers that offer insurance, what factors determine who offers an HMO or a PPO? 3. Among those that offer a fee-for-service plan, what factors explain the decision to self-insure? 4. Do survey respondents classify their plans as self-insured on the basis of the risk they face or on the basis of who administers the plan? 5.What plan and organizational characteristics explain differences in health insurance costs per subscriber? Our results will provide new insights into the determinants of health care cost and will aid policymakers in evaluating the impact of new legislative initiatives on controlling costs.