![]() The key factor is the average health care costs of the enrollees included in the pool. Although larger risk pools are typically more stable, a large risk pool does not necessarily mean lower premiums. Is the size of a risk pool the only factor? In general, the larger the risk pool, the more predictable and stable the premiums can be. Together allows the higher costs of the less healthy to be offset by the relatively lower costs of the healthy, either in a plan overall or within a premium rating category. A health insurance risk pool is a group of individuals whose medical costs are combined to calculate premiums. The pooling of risk is fundamental to the concept of insurance. on behalf of The Cochrane Collaboration.For a print-ready PDF of this page, click here. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. While regulatory research on PHI remains relatively scanty, future research can draw on the rich body of research on the regulation of other health financing interventions such as user fees and results-based provider payments.Ĭopyright © 2021 The Authors. Further studies should assess the different types of regulation (including regulation and licensing, monitoring, auditing, and intelligence). Studies are required in countries at different income levels because the effects of government regulation of PHI are likely to differ across these income and health system settings. ![]() The findings come from studies conducted in the USA and might therefore not be applicable to other countries since the regulatory environment could be different. Our review suggests that, from currently available evidence, it is uncertain whether policies that regulate private health insurance have an effect on utilisation of healthcare services, costs, quality of care, or patient health outcomes. Therefore, we are uncertain of the effects of government mandates on for-profit PHI schemes. We assessed the certainty of evidence for patient health outcomes, and utilisation and costs of healthcare services as very low. ![]() None of the included studies reported on quality of health care and patient health outcomes. All seven studies reported on utilisation of healthcare services, and one study reported on costs. The seven studies were assessed as having 'unclear risk' of bias. Only for-profit PHI schemes were addressed in the included studies and no study addressed other types of PHI (community and not for-profit). We included seven CBA studies, conducted in the USA, and that directly assessed state laws on cancer screening. However, due to the nature of the data obtained, we have provided a narrative synthesis of the findings. We planned to summarise the results (using random-effects or fixed-effect meta-analysis) to produce an overall summary if an average intervention effect across studies was considered meaningful, and we would have discussed the implications of any differences in intervention effects across studies. Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of the evidence resolving discrepancies by consensus. SELECTION CRITERIA: Randomised trials, non-randomised trials, interrupted time series (ITS) studies, and controlled before-after (CBA) studies conducted in any population or setting that assessed one or more of the following interventions that governments use to regulate private health insurance: legislation and licensing, monitoring, auditing, and intelligence. ![]() We also searched selected grey literature databases and web-sites. This complemented the search conducted in February 2017 in IBSS EconLit and Global Health. In November 2019 we searched CENTRAL MEDLINE Embase Sociological Abstracts and Social Services Abstracts ICTRP and Web of Science Core Collection for papers that have cited the included studies. To assess the effects of policies that regulate private health insurance on utilisation, quality, and cost of health care provided. If poorly regulated, PHI can hardly achieve an adequate quantity or quality of population coverage, as can be seen in the USA where a third of adults younger than 65 years of age have no insurance, sporadic coverage or coverage that exposes them to high out-of-pocket healthcare costs. Low- and middle-income countries have the opportunity to learn from this experience to optimise PHI. With the goal of improving access to basic health care for citizens through PHI programmes, several high-income countries have developed strong regulations for PHI schemes. The strain on public resources to meet the healthcare needs of populations through publicly-provided health insurance programmes is increasing and many governments turn to private health insurance (PHI) to ease the pressure on government budgets.
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