Chollet D J
Alpha Center, Washington, DC, USA.
Baxter Health Policy Rev. 1996;2:33-62.
This discussion on likely changes and challenges for the health insurance industry over the coming decade assumes that significant national reform of health care financing for the privately insured population will not occur--or, if it does, that it will mirror the insurance market reforms that many states already have undertaken. First, the changes in private insurance coverage during the past several years are considered, with particular attention to the erosion of employer-based coverage and to the rising influence of public insurance programs--especially Medicaid--on the private insurance market. Next is a description of the changing web of state laws and regulations governing private health insurance. At this writing, virtually every state has enacted or is considering reforms of the small group market to limit what many perceive as unfair or destructive insurer practices and to set new ground rules for competition among insurance arrangements. The changing nature of private insurance contracts in the United States is considered next. Evolving from conventional fee-for-service contracts, private insurance is increasingly a complex mixture of capitation, partial capitation, and reinsurance of capitated arrangements. Finally, this chapter discusses three issues of increasing importance in shaping the marketplace for private insurers: (1) the federal preemption of states' regulatory authority over self-insured employer plans; (2) emerging state regulation to restructure competition in the health insurance and health care markets; and (3) the growing interest of both federal and state governments in medical savings accounts to finance health insurance and health care spending.
关于未来十年医疗保险行业可能发生的变化和面临的挑战的讨论假定，针对私人参保人群的医疗保健融资不会进行重大的全国性改革——或者即便进行改革，也将效仿许多州已经实施的保险市场改革。首先，我们将审视过去几年私人保险覆盖范围的变化，尤其关注基于雇主的保险覆盖范围的缩减以及公共保险计划——特别是医疗补助计划——对私人保险市场的影响日益增大。接下来将描述管理私人医疗保险的州法律法规网络的变化。撰写本文时，几乎每个州都已颁布或正在考虑对小团体市场进行改革，以限制许多人认为不公平或具有破坏性的保险公司做法，并为保险安排之间的竞争制定新的基本规则。接下来将探讨美国私人保险合同不断变化的性质。从传统的按服务收费合同演变而来，私人保险越来越成为人头费、部分人头费以及人头费安排再保险的复杂组合。最后，本章将讨论在塑造私人保险公司市场方面日益重要的三个问题：（1）联邦政府对各州监管自我保险雇主计划的权力的优先行使；（2）新兴的州监管措施，旨在重组医疗保险和医疗保健市场的竞争；（3）联邦和州政府对医疗储蓄账户用于资助医疗保险和医疗保健支出的兴趣日益浓厚。
