Book Review No Benefit: Crisis in America's Health Insurance Industry By Lawrence D. Weiss. 156 pp. Boulder, Colo., Westview Press, 1992. $26.95. 0-8133-1215-9 Curing the Crisis: Options for America's Health Care By Michael D. Reagan. 196 pp. Boulder, Colo., Westview Press, 1992. $49.95 (cloth); $15.95 (paper). 0-8133-8179-7

1993 ◽  
Vol 328 (18) ◽  
pp. 1359-1360
Author(s):  
Joan B. Trauner
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Insurance Industry ◽  
Health Insurance Industry

The U.S. Health Insurance Industry: An Alternative View

1978 ◽  
Vol 8 (3) ◽  
pp. 491-507 ◽  
Author(s):  
Albert Woodward
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Providers ◽  
Insurance Industry ◽  
Alternative View ◽  
Care Providers ◽  
The Great Depression ◽  
Price Leader ◽  
Health Insurance Industry ◽  
The U.S

The health insurance industry in the U.S. can be characterized as a concentrated industry. It has evolved into its current structure as a result of certain historical conditions, particularly those following the Great Depression. The structure of the industry has had an effect on the manner in which the industry functions and the cost increases in the health care sector. Specifically, the pricing mechanism is that of a price leader setting a limit price; health premium prices are higher than would be expected under a competitive structure. Regulation has been ineffective, because it has been dominated historically by health care providers and insurers. The costs of health care in general, and hospital care in particular, have increased beyond what would be expected as a result of “cost-pass-through.”

Getting Health Care Right

2018 ◽  
Vol 46 (4) ◽  
pp. 829-832 ◽  
Author(s):  
Daniel J. Hilferty
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Insurance Industry ◽  
Insurance Market ◽  
Term Change ◽  
Health Insurance Market ◽  
Industry Leader ◽  
Health Insurance Industry ◽  
Near Term

The author, a health insurance industry leader and a prominent voice in the national reform debate, shares his perspective on attempts to transform health care over nearly a decade. He advocates for a bipartisan solution to stabilize the health insurance market in the near term, and for private sector innovation in partnership with government to create sustainable long-term change. He encourages ASLME members to continue to lend their expertise to the process of transformation.

Capitalizing on Illness: The Health Insurance Industry

1974 ◽  
Vol 4 (4) ◽  
pp. 583-598 ◽  
Author(s):  
Thomas Bodenheimer ◽  
Steven Cummings ◽  
Elizabeth Harding
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Access To Health Care ◽  
Insurance Industry ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
Health Insurance Industry

The private health insurance industry in the United States began as a money-collection mechanism for hospitals and doctors, and has evolved into an important profit-making sector of the economy. Blue Cross is dominated by hospital representatives and serves to channel money into the nation's hospitals. Physicians control Blue Shield and are its principal beneficiaries. And commercial insurance companies are closely linked to banks and industrial corporations through the country's large financial empires. Some effects of this elite control over the health insurance industry have been inadequate and distorted insurance coverage, discrimination against the elderly, the sick, and the poor, and rapidly rising medical costs. In addition, the control of Medicare and Medicaid by private insurance institutions has contributed to the enormous inflation produced by these programs. Though governments, consumers, and even the insurance industry itself are beginning to apply controls to the unprecedented medical inflation of the late 1960s, these controls tend to limit access to health care, especially for low-income people. Unless insurance companies are barred from the health care field and a public financing mechanism based on progressive taxation is introduced, health care will never be an equal right for everyone in the United States.

scholarly journals COVID-19 Has Revealed America’s Broken Health Care System: What Can We Learn?

2021 ◽  
pp. 002073142098564
Author(s):  
John Geyman
Keyword(s):  
Public Health ◽  
Health Care ◽  
Insurance Industry ◽  
International Comparisons ◽  
Economic Downturn ◽  
Industrial Complex ◽  
For Profit ◽  
Urgent Task ◽  
Single Payer ◽  
Health Insurance Industry

The COVID-19 pandemic has exposed long-standing system problems of U. S. health care ranging from access barriers, uncontrolled prices and costs, unacceptable quality, widespread disparities and inequities, and marginalization of public health. All of these have been well documented by international comparisons. Our largely privatized market-based system and medical-industrial complex have been ill equipped to respond effectively to the pandemic. The accompanying economic downturn exacerbates these problems that further reveal the failures of our largely for-profit private health insurance industry, dependent as it is on continued government subsidies while it profiteers on the backs of vulnerable Americans. This article brings historical perspective to these problems, and provides markers of the extent of our unpreparedness and ineffective response to the pandemic. Coherent national health and public health policies are urgently needed based on evidence-based science, not political pressures. Financing reform is necessary, such as through single-payer Medicare for All. Eight takeaway lessons are summarized that can help to inform now best to rebuild U. S. health care and public health, an urgent task for the incoming Biden administration.

scholarly journals Health Insurance as a Healthcare Financing Mechanism in India: Key Strategic Insights and a Business Model Perspective

2021 ◽  
pp. 025609092110270
Author(s):  
Rohit Kumar ◽  
Aditya Duggirala
Keyword(s):  
Health Insurance ◽  
Business Model ◽  
Critical Success Factors ◽  
Success Factors ◽  
Insurance Industry ◽  
Insurance Companies ◽  
Healthcare Financing ◽  
Strategic Choices ◽  
Critical Success ◽  
Health Insurance Industry

This study provides strategic insights and a business model perspective on health insurance as a vehicle for financing healthcare. It uses both primary (expert interview) and secondary data to investigate the overall disease burden and healthcare industry trends and track healthcare financing through the health insurance mechanism in India. To identify the critical success factors and to gain a business model perspective within the health insurance industry, telephonic and face-to-face interviews were held with 27 experts in the healthcare, insurance, and strategic management field. The study’s findings suggest that the growth of health insurance as a healthcare financing mechanism in India has been challenged continuously and impacted by multiple changes in the health insurance and healthcare industry over the last decade. One of the critical challenges faced by insurance companies is the high incurred claim ratio. We find the Indian health insurance industry to be very competitive and that the focus on critical success factors can help insurance companies gain a competitive advantage. The health insurance business model is unique, with varying configurations, and broadly comprises strategic choices and consequences. In this article, drawing from the strategic management literature on the resource-based view (RBV) and insights gained from the interviews of healthcare and health insurance experts, we highlight the six critical success factors relevant for competing in the health insurance business. We also list five strategic choices that can help health insurance companies improve their profitability and gain a sustained competitive advantage. We recommend that the insurance companies design and develop an innovative business model centred around lowering the claim ratio and simultaneously increasing the customer willingness to pay. To increase the customer willingness to pay and reduce the claim ratio, the insurance companies should focus on the six critical success factors and invest in the five strategic choices.

Expert Systems in Medicne:Possible Future Effects

1988 ◽  
Vol 4 (1) ◽  
pp. 121-133 ◽  
Author(s):  
P Potthoff ◽  
M. Rothemund ◽  
D. Schwefel ◽  
R. Engelbrecht ◽  
W. van Eimeren
Keyword(s):  
Health Insurance ◽  
Expert Systems ◽  
Medical Profession ◽  
Insurance Industry ◽  
General Medicine ◽  
Practical Application ◽  
Actual Knowledge ◽  
Positive Effects ◽  
The Subject ◽  
Health Insurance Industry

It should be pointed out that during the interviews most of the experts had positive expectations of ESM. The developers are more generally enthusiastic than the prospective users and affected parties who, especially in respect of the diffusion of ESM into practical application, only show a limited optimism.However, the representatives of the medical profession and the health insurance industry were convinced that ESM might contribute to cost-neutral increases of quality in out-patient and in-patient medicine. But we also understood them to say that they consider other developments in medicine to be overriding, for example, a tendency of general medicine towards a more family-oriented medicine and a reduced emphasis on technology-oriented medicine. In respect of the conception shared by developers as well as potential users that over-enthusiastic expectations should rather be restrained, we consider such a balanced expectation of positive effects of ESM to be adequate to the actual knowledge of the subject.

scholarly journals Overt dependence of health insurance industry on healthcare system

2021 ◽  
Vol 26 (1) ◽  
pp. 197-219
Author(s):  
Uma V R ◽  
Ilango V
Keyword(s):  
Health Insurance ◽  
Health Belief Model ◽  
Developing Economies ◽  
Insurance Industry ◽  
Health Belief ◽  
Correlation Technique ◽  
Perceived Vulnerability ◽  
Willingness To Buy ◽  
Health Insurance Industry ◽  
Belief Model

A vast majority of the population in the developing economies remains uninsured. Moreover, the informal sector that employs a larger section of the society is untouched by any of the government scheme. In this study, we use health belief model to examine the factors that induce willingness to buy health insurance among the illness and the non-illness group. A cross-sectional study was conducted on 1,339 participants above 20 years of age of which 351 had contracted illness in the past and 988 had not. Data was collected using questionnaire from four highly populated districts in India. The questionnaire was developed based on the constructs of health belief model. The data was statistically analysed. Kendall’s Tau-b correlation technique was used to explore the relationship between perceived vulnerability and product aversion. Logistic regression was used to find out the odds at which each independent variable, categorised based on the health belief model, contributes to willingness to buy. The model was able to predict 15% of the variance for willingness-to-buy among the illness and 27% among the non-illness groups. Findings suggest that the perceived vulnerability reduced product aversion among the illness group. Mere presence of primary and super-specialty hospitals was not sufficient for the illness group to subscribe for health insurance. Income perceptions emerged as a significant predictor among the illness group. Presence of well-established hospital, income perceptions, and subjective norms were significant predictors among the non-illness group. The growth of the health insurance industry largely depends upon the presence of well-established hospitals. In the absence of adequate healthcare facilities, attempts by the insurers to promote insurance covers will become futile. Insurers should also consider alternate segmentation patterns albeit the present socio-demographic pattern, as the health risk experience differs among individuals.

No Benefit: Crisis in America's Health Insurance Industry

1995 ◽  
Vol 16 (3) ◽  
pp. 370
Author(s):  
Terence E. Carroll ◽  
Lawrence D. Weiss
Keyword(s):  
Health Insurance ◽  
Insurance Industry ◽  
Health Insurance Industry
Sign in / Sign up

Export Citation Format

Share Document