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Reinsurance for High Health Costs: Benefits, Limitations, and Alternatives

  • Dow William H


    (University of California, Berkeley)

  • Fulton Brent D


    (University of California, Berkeley)

  • Baicker Katherine


    (Harvard University)

Government-sponsored reinsurance for individuals with high health costs is a commonly proposed strategy to improve access and affordability in the individual and small-group health insurance markets. While reinsurance may have some benefits, other schemes may be more effective at accomplishing the same goals at lower cost. Reinsurance can be seen as a crude special case of risk-adjusted insurance subsidies. This paper estimates the effect of different reinsurance schemes on insurance premiums and insurersÂ’ disincentives to enroll potentially high-cost individuals. We find that reinsurance is relatively ineffective at reducing cream-skimming incentives and argue that more sophisticated risk-adjustment schemes are more effective, particularly under community rating with guaranteed issue. Although in the past risk adjustment had been considered too complex to implement in practice, recent experience suggests that it is now feasible, and we argue that incorporation of risk adjustment would strengthen current health insurance reform efforts.

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Article provided by De Gruyter in its journal Forum for Health Economics & Policy.

Volume (Year): 13 (2010)
Issue (Month): 2 (July)
Pages: 1-23

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Handle: RePEc:bpj:fhecpo:v:13:y:2010:i:2:n:7
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