title: Self-insurance in times of growing and retreating managed care.
abstract: This paper examines trends in self-insurance and in the content of self-insured plans from 1993 to 2001. The percentage of employees enrolled in self-insured plans fell during these years. Much of the decrease was attributable to the decline of indemnity insurance and the rise of HMO and point-of-service plan enrollment. If the product mix had remained constant throughout these years, self-insured enrollment would have grown between 1993 and 1996 and then declined to its current 50 percent level. As a result of the Health Insurance Portability and Accountability Act (HIPAA), the use of preexisting condition clauses declined dramatically in self-insured plans. Self-insured and purchased plans cost similar amounts and provide similar benefits. Cost sharing is somewhat lower in self-insured PPO plans. During periods of rapid inflation, premiums increase more slowly for self-insured than for fully insured plans.
authors.affiliation: Health System Studies, Health Research and Educational Trust (HRET), Washington, DC, USA.
authors.forename: Jon R
authors.initials: JR
authors.lastname: Gabel
authors.forename: Gail A
authors.initials: GA
authors.lastname: Jensen
authors.forename: Samantha
authors.initials: S
authors.lastname: Hawkins
mesh_terms: D017047:Cost Sharing; D003669:Deductibles and Coinsurance; D005249:Fees and Charges; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends*; D019538:Health Care Surveys; D020408:Health Insurance Portability and Accountability Act; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D007342:Insurance Benefits / Q000706:statistics & numerical data / Q000639:trends; D019458:Insurance Coverage / Q000706:statistics & numerical data / Q000639:trends; D011243:Preferred Provider Organizations / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends; D012306:Risk; D011795:Surveys and Questionnaires; D014481:United States