The Changing World of Group Health Insurance

Abstract

Prologue: The decade of the 1980s has been a period when many of the nation's employers have begun to view medical care as something other than the almost exclusive province of hospitals and physicians. Wielding their influence as payers, many employers began to experiment with employee cost sharing, self-insurance, and alternative delivery systems. In this article, five researchers show how an increasing number of employers have moved in these directions in recent years. Conducted under the auspices of the Health Insurance Association of America (HIAA) , the survey depicts group health insurance as a rapidly changing world. Given the recent round of sharp increases in health insurance premiums that employers have faced, the results of the survey raise an interesting question: Has managed care demonstrated that it can impose the necessary discipline on medical care providers and consumers, or must far more bitter pills be prescribed in the future? Jon Gabel, who formerly worked as a senior economist at the National Center for Health Services Research and Health Care Technology Assessment, is associate director of the Department of Research and Statistics at HIAA. Cindy Jajich-Toth and Howard Cohen are affiliated with the HIAA research department. Gregory de Lissovoy is an assistant professor of economics at The Johns Hopkins University s School of Hygiene and Public Health. Thomas Rice is an assistant professor of health economics at the University of North Carolina's School of Public Health. The article reports the results of the first HIAA national survey of employers and the directions they are moving in the group health insurance market. The association plans to conduct the survey annually, and the results will be reported in Health Affairs every year. The HIAA's survey of employers is one reflection of a broader effort on which the association has embarked under its new president, Carl J. Schramm, to provide the public and policymakers with reliable information on changing health care trends.