Health insurance high risk pools have been mentioned by President Trump and Congressional Republicans as a potential element of their Obamacare replacement plans, but they are not a new idea. Past experience with high risk pools suggests that they can help to address issues of affordability, stability, and fairness in the individual health insurance market. However, to do so, they must be adequately publicly subsidized and have benefit designs and cost-sharing structures that are comparable to health insurance products available on the open market.
High risk pools were initially one of the options that states could adopt under the Health Insurance Portability and Accountability Act (HIPAA) for ensuring portability from the group health…show more content… This arrangement works because the insurance company is able to pool risks from lots of different individuals or organizations. As long as the risks are uncorrelated, the likely cost associated with the pooled risk is much more predictable than for the un-pooled risk.
Many people in the U.S. receive health insurance through their employers, which operate as natural groups to gather individuals into pools. Since most people do not select jobs to get health insurance coverage, there is little reason to believe that the incidence of health care costs for the individuals in the groups established through employment arrangements will be correlated. The individual health insurance market, on the other hand, is referred to in industry jargon as the ‘non-group’ market for a reason. There is no natural group for aggregating individuals into a pool that is established for reasons other than purchasing insurance. There is also reason to believe that the set of individuals seeking to purchase individual/non-group health insurance does not represent a representative sample of the population with respect to health status.
The individual health insurance market is bedeviled by certain empirical realities about health care spending, and characteristics of health insurance markets – the distribution of health care spending is highly skewed, health insurance has a
Risk Pooling in Health Care Finance
Peter C. Smith and Sophie N. Witter
Centre for Health Economics
University of York
York YO10 5DD
United Kingdom
Report prepared for the World Bank Workshop
Resource Allocation and Purchasing in Health: Value for Money, Reaching the Poor
World Bank, Washington DC, May 14-15 2001
Revised November 2001
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Acknowledgements
The authors would like to thank Jack Langenbrunner, Maureen
Throughout the course of history, healthcare has been evolving to accommodate the ever-changing needs of the human body. Along side the developing healthcare system, health insurance has been modified too. To remain profitable, health insurance companies must change their policy to provide coverage for the increasing demand of healthcare services. However, the expansion of healthcare insurance also creates cracks in the system that need to be filled through improved healthcare reform legislation
Community College opened up their pool for use of two more years by the local swim teams. This summer, the local swim teams including Pendleton High School, Hermiston High School and the town club, Pendleton Swim Association were concerned they would not have a pool for this winter’s season and for future seasons. After attending many conferences meetings and fighting for their pool, the swim teams managed to persuade the college board to keep the Pendleton campus pool open for two more years. With these
Pre-existing conditions are conditions that a person had prior to obtaining a health insurance policy. Pre-existing conditions include a variety of chronic conditions, such as obesity, high blood pressure, asthma, diabetes, etc., and acute or short-term conditions, such as pregnancies and accidental injuries (Henry Keiser, 2012). According to Families USA 2012 report “more than 64.8 million non-elderly Americans have been diagnosed with pre-existing conditions” (Families, 2012, p. 1).
The significance
Advantage Disadvantage
Licensing out their core technologies - High royalties fee collected
- Money can invest into R&D - Create competition from external, lower revenue
Licensing in core technologies that lack of - Can complement the lagging technology fast - High cost
- Low control in technology
Cross licensing with Ofo - Higher chance to become dominant power & design - Lower the barrier in competition
Table 2 Comparison of the advantage & disadvantage for Mobike in licensing strategy
Recommendation:
insurance company.
Before 2014, 18 states did not support Obamacare because they did not want to run high risk pools in their state. Starting in 2014 people did have to have the high risk pools regardless of them supporting the bill or not. A lot of states were concerned that if funds run out there can be difficult political choices as a repercussion. These repercussions will include things reducing benefits, raising premiums, or limiting enrollment. These are valid issues, but I feel that we are in this
surgery to resect the primary tumour but this poses high risk of mortality and morbidity when distant metastases are present. In addition, since the patient has experienced significant weight loss and their condition is declining they are not stable enough for surgery (Van der Pool et al., 2012). Surgery is also best suited for tumours located in the left colon rather than the right colon, which is not the case for the discussed patient (Van der Pool et al., 2012). Not being eligible for palliative
* Seasonality – 78% of hot tub sales occur from April 1st to September 30th. In order to remain profitable overall, sales need to increase during the winter months.
* Hydrotherapy – A potential value added service to recommend the therapeutic benefits of hot tubs. Surfside will need to penetrate into this market to increase market share.
* No marketing plan - Increased competition – 12 new competitors have entered the market; 3 being direct. A lack of promotional strategy and
Additionally, midwifery skills is continually polluted by years of managing labour under obstetric vigilance and high end technology. Consequently, the dominance of the medical model over the biological model persisted with a negative implication for midwifery confidence in promoting normal births (RCM, 2014; Lucas, 2011). Hence, change can only be possible if the blame and claim culture of childbirth and birthing without fear is realised for women, midwives and obstetricians (Johanson et al., 2002)