COSTS AND CHARACTERISTICS OF HEALTH INSURANCE PLANS

在1980年到1988年之间，国家的医疗保健费用超过了 翻了一番，从大约2500亿美元增加到5400亿美元。 这一数字从9.1%增加到11.1% 国民生产总值（国家成本估算办公室， 1990年）。 雇主，谁支付的医疗保健的主要份额， 美国通过就业相关的铰链福利， 越来越多地转向自我保险， 管理式护理替代方案，如健康维护组织 （HMO）和首选提供商组织（PPO）试图 来控制这些成本。 尽管付出了这些和其他代价 遏制措施，国家的医疗保健费用预计 继续翱翔 HMO在20世纪80年代经历了快速增长，但 随着更多样化的模式的创造， 联合收割机结合了传统收费服务的元素 (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 选择和成本HMO FFS保险。 虽然很多研究 在预付费计划方面仍有许多工作要做，重要的是要研究 选择和成本因素与不同形式的 按经验收费的保险 我们建议使用数据在雇主层面研究FFS保险 来自1989年健康保险计划调查（SHIP），赞助 卫生保健融资管理局（HCFA）。 1989年船 这是一项全国性的雇主调查，收集了详细的， 具体计划信息。 尽管我们的分析将包括 HMO，我们将专注于收费服务计划。 具体目标 研究的目的是回答以下研究问题： 1 .一、哪些因素决定谁提供健康保险，谁做 不是吗 2.在那些提供保险的雇主中， 决定谁提供健康维护组织或公共财产保护组织 3.在那些提供收费服务计划的公司中， 为什么要选择自我保险 4.调查受访者是否将其计划归类为自我保险， 根据他们面临的风险或根据谁管理 计划 5.哪些计划和组织特征可以解释差异 每个用户的健康保险费用？ 我们的研究结果将提供新的见解的决定因素 医疗保健成本，并将帮助决策者评估影响 控制成本的新立法举措。

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.