This dissertation examines several key aspects regarding health insurance policies in the United States. The development of the United States health insurance market began in the 1920s with life insurance companies selling traditional indemnity health insurance plans and hospitals offering hospital care plans on a pre-paid basis. This market has evolved over the last century into a heavily regulated market dominated by employer-sponsored, managed-care plans. Reviews in the introduction of this dissertation include the overall market, health insurer evolution, the history of managed care operations, the progression of employer-sponsored health insurance plans and regulation specific to health insurance. Analysis of health insurance market evolution can offer a better understanding of how past developments in U.S. health care can inform and shape future policy.
The second chapter of this dissertation provides an analysis of adverse selection in the U.S. health insurance market. Adverse selection is a phenomenon inherent in insurance contracting. Using a rich, unique dataset consisting of multiple insurers, across states for the years 2013–2015, I document a correlation between coverage and risk. Results show that adverse selection is present both in the individual and group markets. Additionally, I test for the presence of adverse selection by state and by insurer. I find that factors such as the health of the state population, regulatory environment, insurer competition and insurer size are not associated with the likelihood that a state or and insurer experiences the presence of adverse selection.
The third chapter of this dissertation relates adverse selection and consumer satisfaction in health insurance plans. I exploit a dataset rich with respondent demographics and health insurance plan information to evaluate the relationship between adverse selection and health insurance plan satisfaction. I find that respondents who are more likely to have adversely selected into the health insurance plan are more satisfied with their plan. This is evidence that respondents may use private information on their risk level to choose plans to their advantage.
|Commitee:||Cole, Cassandra, Nyce, Charles, Steinorth, Petra, Zuehlke, Thomas|
|School:||The Florida State University|
|Department:||Risk Management/Insurance, Real Estate and Legal Studies|
|School Location:||United States -- Florida|
|Source:||DAI-A 79/07(E), Dissertation Abstracts International|
|Subjects:||Business administration, Health care management|
|Keywords:||Asymmetric information, Health insurance|
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