No abstract

Unlike other forms of insurance, individuals with health insurance generally expect to make claims through the policy period. Selecting an appropriate level of cost-sharing is difficult and individuals may, ex-post, regret the choice of a less-than-suitable coverage amount. Using a national health insurance survey of private market consumers from 2013 to 2017, we evaluate the potential for post-purchase regret in the health plan purchasing decision. We employ an ordered logistic model and find that consumers whose plan choices were likely financially dominated by a foregone alternative are significantly more likely to express regret through reporting significantly lower likelihood of renewal, even when controlling for confounding considerations including affordability, self-assessed risk, and satisfaction with the plan.

Following the Patient Protection and Affordable Care Act (ACA), annual financial reports by commercial health insurers include more detailed information on a Supplemental Health Care Exhibit. In this new exhibit, insurers illustrate spending on the provision of medical services and associated expenses. These expenses, which were commonly reported as “claims adjustment” and “general administrative” expenses, can now be allocated to several new categories of expenses associated with combatting fraud and improving patient health care quality. This article illustrates that quality improvement expenses have increased significantly in the individual, small group, and large group markets following implementation of the ACA. Of the five types of quality expenses reported, the greatest proportion of spending has been toward the improvement of health outcomes and the most pronounced increase from 2011 to 2017 has been spending toward increased wellness and health promotion activities, which include activities such as wellness assessments and coaching programs for patients with chronic diseases. Given that the ACA was designed not only to broaden access to health insurance but also to improve health, analysis of the allocations to various types of quality improvement activities highlights the private market's contribution to improving the health of the US population.

No abstract

Recent healthcare reform in the United States, including rating restrictions, imposed substantial changes to health insurer operations. We provide evidence of the presence of adverse selection following the enactment of the Patient Protection and Affordable Care Act of 2010. Using a unique dataset consisting of information on health insurance plans from multiple health insurers, across states for the years 2013-2017, we document a statistically significant correlation between coverage and risk, indicating the presence of adverse selection, that varies over time in both the individual and group markets for health insurance.