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At least 145 records · Page 8Linked to original sources
PubMed2001

Reinsurance of health insurance for the informal sector.

Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the options for stabilization are explained. Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments. The article focuses on risk transfer from micro-insurance units to reinsurance. The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year. The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality.

Community Health Planning↗
PubMed1997

Everybody into the pool! Medicare in the twenty-first century.

Both the President and now Republicans have proposed to slow the growth of Medicare costs by allowing seniors to join private managed care health insurance plans. In this article, the author demonstrates that a private market in health insurance will not function like a "normal" commercial insurance market, will constantly be undermined by adverse selection, and therefore is unlikely to achieve the objectives for which it is being created. This result follows from established principles of commercial insurance and our modern understanding of the pathophysiology of disease.

Aged↗
PubMed1991

Growth in self-insurance puts squeeze on Minnesota risk pool.

HMOs and other health plans in many states are diversifying into self-insurance to protect market share, but in Minnesota such a shift is leading to a growing deficit in the state-sponsored risk pool for uninsurable residents. That's because health plans must pay an assessment based on revenues to help fund the state's plan, but the burgeoning self-insured plans aren't required to ante up.

Data Collection↗
PubMed1988

On taking chances with the law of large numbers.

An increasing number of major purchasers of health services now consider capitation to be the preferred method of payment for individual physicians and small group practices. This paper is a primer on capitation payment plans for small risk pools. It describes some of the basic economic issues that purchasers and providers face when negotiating small-panel capitation contracts, including sources of risk, techniques of risk reduction and risk sharing. An empirical section analyses the experience of a plan that took a chance with the law (law of large numbers) and lost.

Capitation Fee↗
PubMed1988

Uncompensated care pools and care to the uninsured: lessons from the New York Prospective Hospital Reimbursement Methodology.

One policy response to both the growing number of uninsured and the increased volume of uncompensated care is the development of revenue pools to explicitly finance uncompensated care. Despite the growing popularity of this response, few analyses have examined their success in financing uncompensated care and improving access to the uninsured. This study examines one such program developed as part of New York State's all-payer rate-setting system. The results indicate that the revenue pools improved the financial condition of New York hospitals but were less effective in improving access to care by the uninsured. The latter result was traced to the method selected by New York to measure "need" and distribute payments to hospitals. If the goal of such programs is to earmark payments to the uninsured, methods other than the New York system should be employed.

Data Collection↗
PubMed1991

Universal access to health care. A comprehensive tax-based approach.

More than 30 million Americans lack health insurance, and millions more are "underinsured." Meanwhile, the cost of health care in the United States is escalating, and some of our care is of questionable value. This article presents a health care reform strategy that addresses these three fundamental problems in the US health care system. The strategy, designed to empower consumers to make cost-conscious health care choices, combines a universal tax credit that enables all Americans to purchase basic health coverage; insurance reforms including pooling and reinsurance mechanisms; requirements that all employers make insurance available to their employees and that all consumers purchase coverage; and efforts to measure and improve the quality and efficiency of health care services. This strategy would help us to achieve universal health insurance coverage, while creating the proper incentives for cost control. In addition, it can be largely internally financed through savings automatically triggered by its implementation.

Cost Control↗