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Posts tagged ‘health benefit plan’

New paper in Journal of Healthcare Risk Management


Just had my latest paper published in the Journal of Healthcare Risk Management:

Cox, T. (2011), Exposing the true risks of capitation financed healthcare. Journal of Healthcare Risk Management, 30: 34–41. doi: 10.1002/jhrm.20066

The key points:

Small insurers are inefficient insurers: They have lower probabilities of achieving modest profit goals, higher probabilities of incurring operating losses, and higher probabilities of Insurance "not allowed"insolvency than larger insurers when both randomly select policyholders from the same populations.

Small insurers also have to cut benefits to match larger insurer’s probabilities of achieving modest profit goals, avoiding operating losses, and avoiding insolvency.

Despite this, and the obvious impact it has on service quality and quantity, almost every proposal for trimming health care costs assumes Read more

Regulating Medical Loss Ratios


I was just thinking about a new paper in the American Journal of Managed Care:

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Regulating the Medical Loss Ratio: Implications for the Individual Market
Jean M. Abraham, PhD; and Pinar Karaca-Mandic, PhD
(Am J Manag Care. 2011;17(3):211-218)

“Results:In 2009, using a PPACA-adjusted MLR definition, we estimated that 29% of insurer-state observations in the individual market would have MLRs below the 80% minimum, corresponding to 32% of total enrollment. Nine states would have at least one-half of their health insurers below the threshold. If insurers below the MLR threshold exit the market, major coverage disruption could occur for those in poor health; we estimated the range to be between 104,624 and 158,736 member-years.”Conclusion: The introduction of MLR regulation as part of the PPACA has the potential to significantly affect the functioning of the individual market for health insurance.”————————————————————————————————————————

The Robert Wood Johnson Foundation thought enough of it to post it on their website and I did a post over there

http://www.rwjf.org/coverage/product.jsp?id=72089&cid=XEM_910232#disqus_thread

but sometimes they don’t like them, so I’ll edit it and redo it here because I think Read more

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