Author Affiliation: University of California, School of Public Health, Berkeley.
The private health insurance industry in the United States has fundamentally
changed its strategic focus, product design, and pricing policy as a result
of the backlash against managed care. Rather than seek to influence the behavior
of physicians through capitation and utilization review, the major health
plans now seek to influence the behavior of patients through benefit designs
that cover a broad range of services but with high co-payments, tiered network
designs that cover a broad range of physicians but with variable coinsurance,
and medical management programs that provide incentives for patients to better
manage their own health care. Premium prices are carefully adjusted to cover
the expected costs of care for each type of product and each class of patient,
with a commensurate willingness to abandon enrollment where insurance premiums
cannot outrun medical costs. The contemporary product and pricing policies
reflect a retreat by the insurance industry from previous efforts to transform
the health care system and embody a delegation to individual consumers of
responsibility for setting priorities and making financial tradeoffs.
Robinson JC. Reinvention of Health Insurance in the Consumer Era. JAMA. 2004;291(15):1880–1886. doi:10.1001/jama.291.15.1880
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