Escarce and colleagues (1998) examined the effects of rapid Health Maintenance Organization growth on the location decisions of young physicians. They had data on physicians who had completed their graduate medical education between 1989 and 1994 and decided to practice in a U.S. metropolitan area with a population of one-half million or more. (more…)
Health insurance as we generally think of it in the United States began with the Great Depression in the 1930s. In this artilce, we review the history of health insurance and demonstrate how that history is linked to current health insurance developments. Predating private health insurance were efforts at government-sponsored coverage for workplace injury. The Great Depression led hospitals and then physicians to implement forms of insurance as means to assure payment for services. Ironically, conventional insurance and managed care were developed at this same time. (more…)
Since Health Maintenance Organizations (HMOs) do not have a claims database, they were at a disadvantage in participating in rating Medicare when it was introduced in 1965. After a number of largely unsuccessful efforts, Medicare implemented in 1985 the Adjusted Average Per Capita Costs (AAPCC) payment methodology under authorization from Congress in the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). There is a history of Medicare’s approaches to paying managed care plans in its first 35 years. (more…)
The Health Research Educational Trust (HRET) and the Kaiser Family Foundation conduct an annual survey of employers concerning their health insurance coverage. A summary of the findings is readily available on the Kaiser Family Foundation website (www.kff.org/insurance/7031/index.cfm) and in annual summary articles by Jon Gabel and colleagues in a fall or winter issue of Health Affairs. The survey is nationally representative of public and private employers, and is drawn from the Dunn and Bradstreet listing of U.S. firms. Responding establishments are resurveyed in subsequent years. Approximately 1,400 firms respond each year, and the overall annual response rate is approximately 50 percent. (more…)
The 1980s saw rapid increases in health insurance premiums, driven by new medical technology and cost-based reimbursement systems used by insurers and the Medicare program. In 1983 Congress changed the system Medicare used to pay hospitals. Rather than paying based on allowable costs, it introduced the prospective payment system, in which hospitals were paid a fixed price based on the diagnosis of admitted patients. (more…)