Park C H
National Center for Health Statistics, Hyattsville, MD 20782, USA.
Med Care Res Rev. 2000 Sep;57(3):340-60. doi: 10.1177/107755870005700305.
Many large employers prefer to self-insure health plans offered to employees rather than purchase them from insurance companies to save costs and to avoid the burden of complying with varying state mandates. This concerns state governments because they cannot directly regulate self-insured plans. This article describes the prevalence of employer self-insurance for the nation and by state in 1993 and examines what factors, especially state policies, contribute to the national and state variation in the prevalence of self-insurance. Data from the National Employer Health Insurance Survey on 34,604 private sector establishments are analyzed. Variation in the prevalence of self-insurance was largely explained by the firm size of the establishments. After all other factors were examined, very little was added to predict the rate of self-insurance for each state. While state premium taxation and benefits mandates were not associated with self-insurance, small-group reforms were significantly and positively associated with the probability of self-insurance.
许多大型雇主更倾向于为员工提供的健康计划进行自我保险，而不是从保险公司购买，以节省成本并避免遵守各州不同规定的负担。这引起了州政府的关注，因为它们无法直接监管自我保险计划。本文描述了1993年全国及各州雇主自我保险的普及情况，并研究了哪些因素，尤其是州政策，导致了自我保险普及程度在全国和各州的差异。对来自全国雇主健康保险调查的34,604家私营企业的数据进行了分析。自我保险普及程度的差异很大程度上由企业规模来解释。在考察了所有其他因素之后，对于预测每个州的自我保险率几乎没有增加什么内容。虽然州保费税收和福利规定与自我保险无关，但小团体改革与自我保险的可能性显著正相关。
