Risk pooling and regulation: policy and reality in today's individual health insurance market.
Analysis of new data on the relationship between and premiums and coverage in the individual insurance market and health risk shows that actual premiums paid for individual insurance are much less than proportional to risk, and risk levels have a small effect on obtaining coverage. States limiting risk rating in individual insurance display lower premiums for high risks than other states, but such rate regulation leads to an increase in the total number of uninsured people. The effect on risk pooling is small because of the large amount of risk pooling in unregulated individual insurance.
Pauly
Mark V
MV
Health Care Systems Department, Wharton School, University of Pennsylvania, Philadelphia, USA. pauly@wharton.upenn.edu
Herring
Bradley
B
D000367:Age Factors; D002908:Chronic Disease; D005260:Female; D033161:Government Regulation; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D015271:Insurance Pools / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008297:Male; D011907:Rate Setting and Review / Q000379:methods; D012308:Risk Management / Q000379:methods*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013219:State Government; D014481:United States