Topics covered include - at

[Pages:428]Michael A. Morrisey

health insurance

HEALTH INSURANCE

AUPHA/HAP Editorial Board

Sandra Potthoff, Ph.D., Chair University of Minnesota

Simone Cummings, Ph.D. Washington University

Sherril B. Gelmon, Dr.P.H., FACHE Portland State University

Thomas E. Getzen, Ph.D. Temple University

Barry Greene, Ph.D. University of Iowa

Richard S. Kurz, Ph.D. Saint Louis University

Sarah B. Laditka, Ph.D. University of South Carolina

Tim McBride, Ph.D. St. Louis University

Stephen S. Mick, Ph.D. Virginia Commonwealth University

Michael A. Morrisey, Ph.D. University of Alabama-Birmingham

Dawn Oetjen, Ph.D. University of Central Florida

Peter C. Olden, Ph.D. University of Scranton

Lydia M. Reed AUPHA

Sharon B. Schweikhart, Ph.D. The Ohio State University

Nancy H. Shanks, Ph.D. Metropolitan State College of Denver

HEALTH INSURANCE

Michael A. Morrisey, Ph.D.

Health Administration Press, Chicago, Illinois AUPHA Press, Washington, DC AUPHA HAP

Your board, staff, or clients may also benefit from this book's insight. For more information on quantity discounts, contact the Health Administration Press Marketing Manager at (312) 424-9470.

This publication is intended to provide accurate and authoritative information in regard to the subject matter covered. It is sold, or otherwise provided, with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The statements and opinions contained in this book are strictly those of the author(s) and do not represent the official positions of the American College of Healthcare Executives, of the Foundation of the American College of Healthcare Executives, or of the Association of University Programs in Health Administration.

Copyright ? 2008 by the Foundation of the American College of Healthcare Executives. Printed in the United States of America. All rights reserved. This book or parts thereof may not be reproduced in any form without written permission of the publisher.

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Library of Congress Cataloging-in-Publication Data

Morrisey, Michael A. Health insurance / Michael A. Morrisey. p. ; cm. Includes bibliographical references and index. ISBN 978-1-56793-282-9 (alk. paper) 1. Insurance, Health--United States. I. Title. [DNLM: 1. Insurance, Health--economics--United States. W 275 AA1 M8645h 2007] HG9396.M6686 2007 368.38'200973--dc22 2007021732

The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences-Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984.TM

Project manager: Putman Productions, LLC; Cover design: Chris Underdown

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To Elaine

BRIEF CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv Part I An Introduction

1 History of Health Insurance in the United States . . . . . . . . . . . .3 2 A Summary of Insurance Coverage . . . . . . . . . . . . . . . . . . . . . .21 3 The Demand for Health Insurance . . . . . . . . . . . . . . . . . . . . . .33 Part II Issues of Adverse Selection 4 Adverse Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5 Underwriting and Rate Making . . . . . . . . . . . . . . . . . . . . . . . .61 6 Risk Adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 Part III Issues of Moral Hazard 7 Moral Hazard and Prices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93 8 Utilization Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Part IV Managed Care and Selective Contracting 9 Selective Contracting: Managed Care and Hospitals . . . . . . . .131 10 Managed Care and Physicians . . . . . . . . . . . . . . . . . . . . . . . . .147 11 Managed Care Backlash, Provider Consolidation,

Monopsony Power, and Most Favored Nation Clauses . . . . . .157 Part V Employer-Sponsored Health Insurance

12 Premium Sensitivity for Health Insurance . . . . . . . . . . . . . . . .177 13 Compensating Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . .189

vii

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