Mueller M S
Soc Secur Bull. 1977 Jun;40(6):3-21.
More improvement in the scope than in the quality of private health insurance coverage took place during 1975. Four-fifths of the population under age 65 was covered for hospital and surgical care, and nearly that proportion was protected against the costs of physicians' in-hospital visits, X-ray and laboratory examinations, and prescribed out-of-hospital drugs. The $33.6 billion in premiums paid by consumers resulted in the return of only $28.9 billion in benefits, which covered just 44% of their total personal health care expenditures. Major-medical insurance, held by an estimated 43% of the population, helped to overcome some of the deficiencies of private insurance--dollar limitations on health care services, ceilings on the duration of hospital stays, and exclusions for some types of care. It also provided economic protection against catastrophic expenses. Premiums and subscription income rose faster than benefits as private insurers attempted to keep their coverage in line with rising health care costs. The overall underwriting gain was due largely to a $952.4 million gain in group business by the insurance companies.
1975年期间，私人医疗保险覆盖范围的改善更多体现在广度而非质量上。65岁以下五分之四的人口享有住院和外科护理保险，几乎相同比例的人口能免受医生住院诊疗、X光和实验室检查以及院外处方药费用的困扰。消费者支付的336亿美元保费仅带来了289亿美元的赔付，这仅覆盖了他们个人医疗保健总支出的44%。估计有43%的人口持有大病医疗保险，这有助于克服私人保险的一些不足——医疗服务的美元限额、住院天数上限以及某些类型护理的排除条款。它还为灾难性费用提供了经济保障。随着私人保险公司试图使其保险范围与不断上涨的医疗保健成本保持一致，保费和认购收入的增长速度超过了赔付。总体承保利润主要得益于保险公司团体业务获得的9.524亿美元收益。
