Saturday, February 25, 2006

How about some premium insurance?

As is the case every year, the Federal Government has announced how much it will allow private health insurance companies to increase their premiums. One might wonder why the Government should play a role in setting private health insurance premiums. And the answer is simple: it is paying for 30 percent of them and so has an interest in what they are.

But why, you might ask, can't competition between insurers 'regulate' the price? And the answer again is: the Government is paying a 30 percent premium. That means that if individual households search around for lower premiums, in effect, they only keep 70 percent of the savings. Not surprisingly, the Government distrusts that households will use their powers of consumer choice so as to allow competition to work. Add to that the possibility that consumers aren't necessarily so shrewd and rational when it comes to such things and the fact that it is hard to compare health insurance offerings anyway (it is a good example of a 'confusopoly') and we can't expect competition to be effective.

What we are left with, in contrast, is a terrible regulatory regime whereby the health insurers petition the Government for a fee rise based on their own cost increases and usually get it (or most of it). This reduces their incentives to contain costs and lo and behold we are footing the bill. Not just the average $150 rise in premiums but an additional $45 in public expenditures. This is not the sort of regulatory deal we put up with in other sectors such as energy and even telecommunications. (Boy, would Telstra love the health insurance deal!)

What is more is that there are several simple options at the Government's disposal to change this situation. One option is to change the health insurance rebate. As Stephen King and I have demonstrated a lump sum (or dollar) payment rather than a percentage would remove many distortions: including that to the incentives of consumers to search for lower premiums.

Another option would be to move to a modern system of price regulation. Incentive regulation sets the caps on prices (or in this case premiums) independently of short-run changes in the costs of individual firms. This is usually done by referencing some benchmark. While the choice of benchmark can often be contentious, in health care, benchmarking for the Government is easy: it could base the annual rise in private health insurance costs on the increase (if any) in Government expenditures on relevant public health services. Something it not only observes but can control.

Better still, if Government could get rid of the rebate entirely and subsidise private hospitals and medical expenses directly based on the same cost benchmarks as the public system. The would eliminate the need for regulation altogether and put the annual round of increases into the past. Indeed, this is only one of the benefits that might come from this more major type of reform.

You can read more about this in the book by myself and Stephen King, Finishing the Job (published in 2003) or in this op ed or this short article.

Only by doing something like this can we, as health consumers, get some real insurance -- over premiums as well as health expenditures.

2 comments:

FXH said...

subsidise private hospitals and medical expenses directly based on the same cost benchmarks as the public system.

Why subsidise the private system when the public system can do it cheaper both at the margins and at the average cost?

The public system has offered the private system the public cost units (casemix)for ages. No one will take it up. Why?

Bill said...

So many difficulties arise from this game of musical chairs between providers, insurers, patients and device and drug companies. As many of the cost increases faced by insurers are due to price increases for drugs and devices, how much of this problem could be addressed by:
a)different approaches to fund reimbursement levels; and/or
b)adjustments to the intellectual property laws (with consequent trade agreement effects)?