Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

9
Insuring Persons in High-Risk Categories

James Larson

A recent government report ( GAO 1990a) indicates that health benefits in some large firms are beginning to erode, due to rapidly increasing health care costs. Companies are placing limitations on those covered, including retiree and dependent coverage, and are hiring more part-time workers. In addition, more companies are opting for self-insurance, in which the company itself is the health insurer of its employees. The principal benefit of self-insurance to the company is that it exempts them from state laws that regulate insurance companies. These laws may require insurance companies to provide coverage that is unprofitable but in the public interest ( GAO, 1990a: 14).

If cost containment is beginning to hurt gainfully employed individuals in large corporations, what about those who have difficulty obtaining insurance? What about the poor, the disabled, those with AIDS, and the elderly? How do the concepts of risk versus equity relate to the insuring of these individuals through public or private insurance? That is the subject of this chapter.

However, before turning to each of these groups and discussing their unique problems in obtaining adequate health insurance coverage, a brief examination of the private-public health insurance structure in the United States would be useful. About 60 percent of the U.S. population finance their health care either through private insurance or direct payment to health care professionals ( Leichter and Rodgers, 1984:70). Private insurance accounts for about 35 percent of this amount and direct payments about 25 percent. Of those who purchase private insurance, over 90 percent do so

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