Consolidation And The Transformation Of Competition In Health Insurance

Robinson, James C.

doi:10.1377/hlthaff.23.6.11

Cited by 114 publications

(54 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While the wave of hospital mergers in the 1990s gave way to numerous studies of the implications of hospital consolidation, newfound attention in recent years has focused on consolidation in the US health insurance industry. Robinson (2004) documents the increasing concentration of these markets over the first half of the 2000s, as well as the predominance of insurance markets dominated by a small number of large, nationwide insurers. Similarly, a report from the American Medical Association (2013) highlights the preponderance of health insurance markets across the country that are highly concentrated, as defined by the standards set forth by the Department of Justice (DOJ) and Federal Trade Commission (FTC) in their Horizontal Merger Guidelines (2010).…”

Section: Introductionmentioning

confidence: 99%

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

Trish

Herring

2015

Journal of Health Economics

View full text Add to dashboard Cite

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans' transactions with employers and the other concentration measure representing insurers' bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration.

show abstract

Section: Introductionmentioning

confidence: 99%

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

Trish

Herring

2015

Journal of Health Economics

View full text Add to dashboard Cite

show abstract

“…Private health insurance markets are characterized by high market concentration at the state level (Robinson, 2004;American Medical Association, 2007;GAO, 2009). Concentration is much lower when measured at the national level.…”

Section: Competition and Market Structurementioning

confidence: 99%

The Health Insurance Reform Debate

Harrington

2009

SSRN Journal

View full text Add to dashboard Cite

This article provides an overview of the U.S. health care reform debate and legislation, with a focus on health insurance. Following a synopsis of the main problems that confront U.S. health care and insurance, it outlines the health care reform bills in the U.S. House and Senate as of early December 2009, including the key provisions for expanding and regulating health insurance, and projections of the proposals' costs, funding, and impact on the number of people with insurance. The article then discusses (1) the potential effects of the mandate that individuals have health insurance in conjunction with proposed premium subsidies and health insurance underwriting and rating restrictions, (2) the proposed creation of a public health insurance plan and/or nonprofit cooperatives, and (3) provisions that would modify permissible grounds for health policy rescission and repeal the limited antitrust exemption for health and medical liability insurance. It concludes by contrasting the reform bills with market-oriented proposals and with brief perspective on future developments. Disciplines Economics | Insurance AbstractThis article provides an overview of the U.S. health care reform debate and legislation, with a focus on health insurance. Following a synopsis of the main problems that confront U.S. health care and insurance, it outlines the health care reform bills in the U.S. House and Senate, including the key provisions for expanding and regulating health insurance, and projections of the proposals' costs, funding, and impact on the number of people with insurance. The article then discusses (1) the potential effects of the mandate that individuals have health insurance in conjunction with proposed premium subsidies and health insurance underwriting and rating restrictions, (2) the proposed creation of a public health insurance plan and/or non-profit cooperatives, and (3) provisions that would modify permissible grounds for health policy rescission and repeal the limited antitrust exemption for health and medical liability insurance. It concludes by contrasting the reform bills with market-oriented proposals and with brief perspective on future developments.

show abstract

“…In recent years, competition between insurers has been decreasing due to conglomeration of large insurers 2 . Through the Affordable Care Act (ACA), Congress attempted to improve the competitiveness of the insurance marketplace for individual buyers with the creation of online exchanges that facilitated comparison of plans and prices by consumers 3 .…”

Section: Introductionmentioning

confidence: 99%

Do Insurers Compete on the Federal Health Insurance Exchange?

et al. 2015

View full text Add to dashboard Cite

Background: On the U.S. Federal Health Insurance Exchange established by the Affordable Care Act, states with fewer insurers have higher insurance premiums than states with more insurers. This expected feature of a competitive market has not been studied within states, however. We tested the hypothesis that insurance premiums decrease in more competitive geographic rating areas within states in the U.S.A.Methodology/principle findings: This cross-sectional study utilized publicly available premiums from the Federal Health Insurance Exchange website, www.healthcare.gov. Univariate and multivariate analyses were used to model premiums based on the number of insurers in geographic rating areas. The relationship between premiums and the number of insurers competing in a geographic rating area was also calculated for each unique insurance plan offered on the exchange. The data set and statistical code used for this research is linked in the publication. We found that there was an unexpected, marginally positive relationship between average monthly premiums and the number of insurers in a geographic rating area (+$5.71 in monthly premiums per additional insurer, p<0.001). We also found that identical plans tend to be offered with marginally higher premiums in rating areas with more insurers (+$3.18 in monthly premiums per additional insurer, p=0.002), contrary to the relationship we expected from a competitive marketplace. The principle limitation of the study is that this unexpected relationship, which suggests a lack of competitiveness of this early market, could be due to unobserved confounding factors that influence pricing in more competitive rating areas.Conclusion: On the Federal Health Insurance Exchange, the price of insurance is higher in more competitive rating areas within states. This may be explained by lack of competition in this early stage market.

show abstract

Consolidation And The Transformation Of Competition In Health Insurance

Cited by 114 publications

References 9 publications

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

The Health Insurance Reform Debate

Do Insurers Compete on the Federal Health Insurance Exchange?

Contact Info

Product

Resources

About