Texas State Planning Grant Conference January 31 February 1, 2002
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1 Texas State Planning Grant Conference January 31 February 1, 2002 The Economics of Health Insurance Tim D. Lee, FSA, MAAA Houston TX (713)
2 The Economics of Health Insurance Where Does the Premium Go? What Drives the Cost of Medical Care? How Do Insurance Companies Determine Their Premium Rate? Source: Health Cost Guidelines
3 Where Does the Premium Go? 100 Employee Group Medical Claims, Administrative Expense & Profit $200 $160 $120 80% $80 $40 20% $0 Medical Claims Administrative Expense & Profit Source: Health Cost Guidelines
4 Where Does the Premium Go? 100 Employee Group Break-down of Medical Claims $200 $160 $120 30% 30% Hospital Physician RX Other Med Administrative Expense & Profit $80 $40 15% 5% 20% $0 Source: Health Cost Guidelines
5 Where Does the Premium Go? 100 Employee Group Break-down of Administrative Expense & Profit $40 7% 5% 3% $0 3% 2% Provider Relations/Member Services/Financial Mgt. Claims Processing Commissions Profit Premium Tax
6 Where Does the Premium Go? 100 Employee Group Break-down of Medical Claims, Administrative Expense & Profit $200 Hospital Physician $180 $160 $140 $120 $100 80% RX Other Med Provider Relations/Member Services/Financial Mgt. Claims Processing Commissions Profit Premium Tax $80 $60 $40 20% $20 $0 Source: Health Cost Guidelines
7 Where Does the Premium Go? Small Group vs. Medium Group vs. Large Group $240 $200 $160 $168 70% $160 80% $120 $ % $80 $40 $0 $72 10 Employee Group 30% $ Employee Group 20% $20 10,000 Employee Group 8.3% Medical Claims Administrative Expense & Profit
8 Where Does the Premium Go? Individual Insurance $240 $200 $160 $120 $80 60% Medical Claims Provider Relations/Member Services/Financial Mgt. Claims Processing Commissions Profit Premium Tax $40 40% $0
9 Where Does the Premium Go? Individual vs. Small Group vs. Medium Group vs. Large Group Medical Claims Administrative Expense & Profit $240 $200 $160 60% 70% $120 80% 91.7% $80 40% $40 $0 Individual 30% 10 Employee Group 20% 100 Employee Group 8.3% 10,000 Employee Group
10 Where Does the Premium Go? Conclusions: Premium is primarily driven by the cost of medical claims. Administrative costs are relatively minor and inflexible. Portion spent on administration shrinks as groups get larger. Insurer profits are a very small piece of the total premium.
11 What Drives the Cost of Medical Care? Type of Service Used Frequency of Use (Utilization) Provider s Charge for Service
12 Sample Costs Per Member Type of Service Annual Utilization Charge Per Service Annual Cost Inpatient Hospital.3 days x $2,500 = $750 Physician Visits 3.0 visits x $60 = $180 Pharmacy 7.0 prescriptions x $50 = $350 Source: Health Cost Guidelines
13 New Types of Services
14 How Do Medical Costs Vary By Age and Gender? Annual Average = $2,600 Per Member Age Male Female $3,600 $1,050 $1,150 $1,600 $2,500 $4,600 $7,500 $3,600 $1,050 $2,000 $2,900 $3,800 $5,200 $6,900 Source: Health Cost Guidelines
15 How Do Medical Costs Vary By Age and Gender? $7,500 Male Female $7,000 $6,500 $6,000 $5,500 $5,000 $4,500 $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $ Source: Health Cost Guidelines AGE
16 How Do Medical Costs Vary By Geographic Area? National Annual Average = $2,600 Per Member Area Galveston Tyler Houston Dallas El Paso Ft. Worth Wichita Falls Amount $3,040 $2,800 $2,630 $2,550 $2,340 $2,240 $2,160 Source: Health Cost Guidelines
17 How Do Medical Costs Vary By Provider? 2001 Charges in Austin/San Marcos Service 25 th 25 th Percentile 75 th 75 th Percentile Physician Office Visit CPT Coronary Artery Bypass CPT Hospital Outpatient Septoplasty CPT Cataract Removal CPT $43 $6,326 $2,117 $2,031 $56 $7,092 $3,629 $3,188 Source: Ingenix MDR Payment System
18 How Do Medical Costs Vary By Benefit Plan? Indemnity Plan HMO Plan Plan Benefits = 79% of Charges Plan Benefits = 79% of Changes Plan Benefits = 93% of Charges Plan Benefits 20% Coinsurance $500 Deductible Plan Benefits Copays Source: Health Cost Guidelines
19 How Do Medical Costs Vary By Insurance Product? Inpatient Hospital Costs Per Member Type of Delivery System Annual Utilization Charge Per Service Annual Cost Savings Unmanaged.3 days x $2,500 = $750 0% Discounts (PPO).3 days x $1,500 = $450 40% Discounts and Utilization Management (HMOs).2 days x $1,500 = $300 60% Source: Health Cost Guidelines
20 How Does Underwriting Affect Medical Costs? Policy Year 180 Large Group Average Source: Health Cost Guidelines
21 Why Do Insurers Underwrite? Percent Distribution of Medicare Persons Served and Program Payments Under Medicare: CY 1997 $29.8 Million Persons Served $175.4 Billion in Program Payments $25,000 or More $10,000-$24, % 9.4% Amount of Program Payments $5,000-$9,999 $2,000-$4,999 $500-$1,999 $1-$ % 13.8% 26.4% 36.0% Percent of Persons Served 1.2% 50.1% 26.5% 10.2% 7.3% 4.7% Percent of Program Payments Source: Health Care Financing Administration, Office of Information Services: Data from the Medicare Decision Support System; data development by the Office of Strategic Planning. $25,000 or More $10,000-$24,999 $5,000-$9,999 $2,000-$4,999 $500-$1,999 $1-$499
22 How Do Insurance Companies Determine Their Premium Rate? Estimate Medical Costs Using Some Objective Criteria: Product (Indemnity, PPO, HMO) Plan Benefits Age Gender Geographical Area
23 How Do Insurance Companies Determine Their Premium Rate? Estimate Medical Costs Using Some Objective Criteria: Product (Indemnity, PPO, HMO) Plan Benefits Age Gender Geographical Area Adjust the Estimate for Underwriting Information (Objective and Subjective)
24 How Do Insurance Companies Determine Their Premium Rate? Estimate Medical Costs Using Some Objective Criteria: Product (Indemnity, PPO, HMO) Plan Benefits Age Gender Geographical Area Adjust the Estimate for Underwriting Information (Objective and Subjective) Add Expected Administrative Expenses and Profit Product Group Size
25 The Economics of Health Insurance Summary Premiums Are High Because the Cost of Medical Care is High Some Administrative Cost Savings Possible For Small Groups; But Not a Significant Impact On Affordability Expected Cost of Medical Care Can Vary Significantly Among Small Groups; That s Why Premiums Will Vary Among Groups To Make Premiums Affordable, Focus On The Cost of Medical Care
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