Texas Fully-Insured vs Self-Insured Enrollment Breakdown Among The BUCA’s

fullyinsured

A December 2011 study published by HealthLeaders InterStudy Group on the Texas health insurance market is an interesting read. For example, Blue Cross, United HealthCare, Cigna and Aetna (BUCA) show that more than half of their Texas large group enrollment are on self-funded plans versus fully-insured plans.

According to this report, 55% of Blue Cross’s large group enrollment is self-funded while Cigna’s and Aetna’s are in excess of 80% followed closely by United HealthCare at 75%.

Editor’s Note: With ACA taking full effect in 2014 we expect more employers will self-fund and these numbers will increase. For a copy of the report, write RiskManager@RiskManagers.us

 

Better Care At Lower Cost. Is It Possible?

By Deborah Lorper

Even if you’re not an expert on health care or the Affordable Care Act, you’ve probably heard that the costs of care in the United States are high—really high. Maybe you’ve even heard that the U.S. spends more on health care than any other country. But what does it mean? Why does it happen? And can we do anything about it?

For starters, the $2.9 trillion we spend annually on health care—a whopping $9,200 per person—isn’t necessarily buying us the best care or ensuring good health. In fact, not only does the U.S. fare worse in terms of infant mortality and life expectancy than other developed nations, it also tops the list for deaths that are considered preventable with timely and appropriate treatment. What’s more, a hospital stay or common diagnostic tests, like MRIs, cost many times more in the U.S. than in countries like Germany or Japan.

These high costs place a heavy burden on government, which funds Medicare, Medicaid, and other public insurance programs; on employers, who help pay for the health coverage of workers and their families; and on American households, who feel the pain in their pocketbooks, through higher taxes and reduced wages.

GETTING AT THE ROOT OF THE PROBLEM Penny Before we learn about these new approaches to paying for health care, let’s take a closer look at where costs really pile up.

Paying for More Doesn’t Always Get Your More Many experts point to the way health care providers in the U.S. are typically paid for the services they deliver as a major culprit in driving our out-of-control costs. Under our fee-for-service system, most physicians, hospitals, and other providers receive a payment for each service, be it an office visit, lab test, or medical procedure—regardless of whether or not they help (or harm) the patient. In other words, provider payment is based on the quantity of care provided, rather than the care actually needed by the patient, or the effectiveness of the treatment.

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