Solutions to counter adverse selection in Managed Health Care
During the class sessions of ECON 253, we have discussed the basics of social insurance and hence, took a broad view on the US health care market. The US health care industry is massive as it employs about 10 million people and accounts for about 13.5 percent of GDP.
Interestingly, only 17 percent of total health expenses are paid out of pocket through consumers – private insurance pays 35 percent, government 45 percent.
After 2nd World War, health insurance had been crucially provided by government. Until today, there are three key programs: Medicaid, Medicare and the implicit subsidy for private insurance embodied in the federal income tax system.
The reasons for public provision are especially
Private insurance in the USA is mainly provided by employers as a part of compensation. Consequently, there is a trade-off between the amount of health insurance and the level of wages. In the last two decades, employers started to vary how health care is provided under the policies they offer: instead of using a system called cost.
Carve-outs create new administrative costs that appear to range from 8 to 15 percent of MH/SA benefit costs. It is to determine whether those costs are at least balanced through gains of less selection effects. Researchers claim that selection incentives associated with integrated competing health plans may be quite strong and in many cases will outweigh disadvantages of the carve-out form.
In this study, researchers compared medical costs, hospital stay lengths, and selected illness rates of 40,861 children and adolescents covered by AFDC or Medicaid during the year before either enrolling in an HMO or not enrolling (the control group).
Competitive health plans will seek to discourage enrollment of high-cost enrollees by not offering an attractive MH/SA benefit.