Feldstein P J, Wickizer T M
Graduate School of Management, University of California at Irvine 92717, USA.
Med Care. 1995 Oct;33(10):1035-50. doi: 10.1097/00005650-199510000-00005.
The rate of increase in health care expenditures has been a central policy concern for well over a decade, yet little empirical research has been conducted to examine expenditure growth rates. This study analyzed health insurance premium growth rates for a selected sample of 95 insured groups over the period 1985 to 1992. During this time, premiums increased by approximately 150% in nominal terms and by 45% in real terms. The observed rate of growth was not constant over time, however. The most rapid growth occurred during the years 1986 to 1989; thereafter, the rate of increase in premiums declined. Multivariate analysis was conducted to assess the effects on premium growth rates of selected variables representing insurance benefit design features, market competitive factors, insurance system factors, and group-specific factors. In addition to the percentage increase in benefit payments, other factors found to affect premium growth rates were health maintenance organization market penetration, deductible level, the coinsurance rate, and state insurance mandates. Further, this analysis suggests that the insurance underwriting cycle may play an important role in influencing insurance premium growth rates. These results support the belief that health maintenance organization induced competition has potential to control the rate of increase in health care costs.
十多年来，医疗保健支出的增长速度一直是核心政策关注点，但很少有实证研究来考察支出增长率。本研究分析了1985年至1992年期间95个参保群体的选定样本的健康保险保费增长率。在此期间，保费名义上增长了约150%，实际增长了45%。然而，观察到的增长率并非随时间恒定不变。增长最快的时期是1986年至1989年；此后，保费增长率下降。进行了多变量分析，以评估代表保险福利设计特征、市场竞争因素、保险制度因素和特定群体因素的选定变量对保费增长率的影响。除了福利支付的百分比增长外，发现影响保费增长率的其他因素包括健康维护组织的市场渗透率、免赔额水平、共保率和州保险授权。此外，该分析表明保险承保周期可能在影响保险费增长率方面发挥重要作用。这些结果支持了这样一种观点，即健康维护组织引发的竞争有可能控制医疗保健成本的增长速度。
