Size Matters: The Health Insurance Market for Small Firms

Summary

First published in 1999, this volume responds to a large and growing interest among health policy and research circles on the use of purchasing alliances to leverage change in health care. This book gives detailed and useful specifics on how a leading alliance has fared in California, the most competitive health care market in the United States. Although it is generally accepted that large organizations are more effective purchasers of health insurance, little work has been done to carefully examine the reasons that underlie that phenomenon. Yet, creating interventions and designing potential solutions requires a thorough understanding of the issues. The econometric analysis adds to the limited literature on the influence of premium on choice behaviour for employees of small firms, and introduces an analysis of choice behaviour in a purchasing cooperative setting. The political section of this book presents a much more detailed historical account and analysis of California’s small group market reforms, the most significant health-related legislation in the state in the prior decade, than has been previously available. The conclusions are becoming particularly relevant, both in California and elsewhere, as the issues of reform of the individual market for health insurance comes to the forefront.

Table of Contents

1. The Small Firm as a Purchaser. 2. The Political History of California’s Reforms. 3. Effect of Premium on Health Plan Choice in a Purchasing Alliance.

Author(s) Bio

Jill Yegain Mathews

Reviews

’...an excellent analysis of the experiences of the purchasing alliances and new regulatory guidelines for small firms in California, the most important of the nation’s experiments in the health insurance market. There are important lessons here for both public and private sector initiatives.’ Professor James C. Robinson, University of California, Berkeley, USA ’...both informative and breaks new ground in studying health care in the U.S...focuses on a well-defined niche and examines the operative political and economic mechanisms in microanalytic detail. This is demanding, yet holds great promise as a strategy for investigating other parts of the health care delivery system that have so far defied analysis.’ Professor Oliver E. Williamson, University of California, Berkeley, USA ’This is a welcome addition to the limited sources available on one of the skeletons in the closet of America: how can a country that spends around 13% of GDP on health care still have 17% of its non-elderly population uninsured?’ Pharma Pricing & Reimbursement