The impact of blue cross conversions on health spending and the uninsured

Health Affairs

Volumn 24, Issue 2, 2005, Pages 473-482

  Conover, Christopher J ^a   Hall, Mark A ^b   Ostermann, Jan ^c  

^a DUKE UNIVERSITY   (United States)

^b WAKE FOREST SCHOOL OF MEDICINE   (United States)

^c Duke's Ctr Hlth Plcy Law Mgmt   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DATA ANALYSIS; HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE ORGANIZATION; HEALTH CARE POLICY; HEALTH INSURANCE; HOSPITAL; MARKET; MEASUREMENT; MULTIVARIATE ANALYSIS; UNITED STATES;

BLUE CROSS; FEES AND CHARGES; HEALTH EXPENDITURES; HEALTH SERVICES ACCESSIBILITY; INSURANCE COVERAGE; MEDICALLY UNINSURED; UNITED STATES;

EID: 17244383298     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.24.2.473     Document Type: Article

References (30)

1. Some case studies of various conversion efforts include Community Catalyst, "Getting to No: How Kansas Advocates Derailed the Anthem Steamroller," States of Health 11, no. 4 (2002); J.C. Robinson, "For-Profit Non-Conversion and Regulatory Firestorm at CareFirst BlueCross BlueShield," Health Affairs 23, no. 4 (2004): 68-83; and J.C. Robinson, "The Curious Conversion of Empire Blue Cross," Health Affairs 22, no. 4 (2003): 100-118.
2. Some case studies of various conversion efforts include Community Catalyst, "Getting to No: How Kansas Advocates Derailed the Anthem Steamroller," States of Health 11, no. 4 (2002); J.C. Robinson, "For-Profit Non-Conversion and Regulatory Firestorm at CareFirst BlueCross BlueShield," Health Affairs 23, no. 4 (2004): 68-83; and J.C. Robinson, "The Curious Conversion of Empire Blue Cross," Health Affairs 22, no. 4 (2003): 100-118.
3. Some case studies of various conversion efforts include Community Catalyst, "Getting to No: How Kansas Advocates Derailed the Anthem Steamroller," States of Health 11, no. 4 (2002); J.C. Robinson, "For-Profit Non-Conversion and Regulatory Firestorm at CareFirst BlueCross BlueShield," Health Affairs 23, no. 4 (2004): 68-83; and J.C. Robinson, "The Curious Conversion of Empire Blue Cross," Health Affairs 22, no. 4 (2003): 100-118.
4. J.M. Grossman and B.C. Strunk, For-Profit Conversions and Merger Trends among Blue Cross Blue Shield Health Plans, Issue Brief no. 76 (Washington: Center for Studying Health System Change, 2004).
5. J. Donohue, "Jersey Renews 'For-Profit' Talks with Horizon," Star-Ledger, 12 February 2004; and M. Freudenheim, "California Backs Merger of Two Giant Blue Cross Plans," New York Times, 10 September 2004.
6. J. Donohue, "Jersey Renews 'For-Profit' Talks with Horizon," Star-Ledger, 12 February 2004; and M. Freudenheim, "California Backs Merger of Two Giant Blue Cross Plans," New York Times, 10 September 2004.
7. M.A. Hall and C.J. Conover, "The Impact of Blue Cross Conversions on Accessibility, Affordability, and the Public Interest," Milbank Quarterly 81, no. 4 (2003): 509-542.
8. J.C. Robinson, "Consolidation and the Transformation of Competition in Health Insurance," Health Affairs 23, no. 6 (2004): 11-24.
9. Hall and Conover, "The Impact of Blue Cross Conversions."
10. Ibid., 523-524; and C.J. Conover and M.A. Hall, Assessment of Potential Impact on Accessibility and Affordability of Health Care, Report to the North Carolina Commissioner of Insurance, April 2003, www.hpolicy.duke.edu/ cyberexchange/issues/regulation/insurance.htm.
11. Ibid., 523-524; and C.J. Conover and M.A. Hall, Assessment of Potential Impact on Accessibility and Affordability of Health Care, Report to the North Carolina Commissioner of Insurance, April 2003, www.hpolicy.duke.edu/ cyberexchange/issues/regulation/insurance.htm.
12. D.J. Chollet, A.M. Kirk, and M.E. Chow, Mapping State Health Insurance Markets (Washington: AcademyHealth, 2000); and R.W. McCann, "Blue Cross - What Happened?" in Health Law Handbook, ed. A.G. Gosfield (St. Paul, Minn.: Thomson/West, 2003), 725-799.
13. D.J. Chollet, A.M. Kirk, and M.E. Chow, Mapping State Health Insurance Markets (Washington: AcademyHealth, 2000); and R.W. McCann, "Blue Cross - What Happened?" in Health Law Handbook, ed. A.G. Gosfield (St. Paul, Minn.: Thomson/West, 2003), 725-799.
14. Hall and Conover, "The Impact of Blue Cross Conversions."
15. Centers for Medicare and Medicaid Services, "1980-1998 State Health Care Expenditures Tables," www.cms.hhs.gov/statistics/nhe/state-estimates- provider (16 December 2004).
16. Figures for 1988-2003 are reported in Bureau of the Census, "Table HI-4. Health Insurance Coverage Status and Type of Coverage by State, All People: 1987 to 2002," www.census.gov/hhes/ hlthins/historic/hihistt4.html (16 December 2004). Figures for 1980-1987 were calculated by the authors from March Current Population Survey (CPS) data.
17. Complete data sources are listed at Center for Health Policy, Law, and Management, "Insurance Regulation," www.hpolicy.duke.edu/ cyberexchange/issues/regulation/insurance.htm (17 December 2004).
18. J.M. Grossman and B.C. Strunk, "Blue Plans: Paying the Blues No More," in Understanding Health System Change: Local Markets, National Trends, ed. P.B. Ginsburg and C.S. Lesser (Chicago: Health Administration Press, 2001), 37-60.
19. K. Swartz and P.J. Purcell, "Counting Uninsured Americans" (Letter), Health Affairs 8, no. 4 (1989): 193-197.
20. More complete results are reported at Center for Health Policy, Law, and Management, "Regulation," www.hpolicy.duke.edu/cyberexchange/issues/ regulation/insurance/impactpaper.pdf.
21. See ibid, for fuller alternative model results.
22. M.S. Marquis and C.E. Phelps, Demand for Supplementary Health Insurance, Pub. no. R-3285-HHS (Santa Monica, Calif.: RAND, July 1985).
23. Hall and Conover, "The Impact of Blue Cross Conversions."
24. S.E. Foreman, J.A. Wilson, and R.M. Scheffler, "Monopoly, Monopsony, and Contestability in Health Insurance: A Study of Blue Cross Plans," Economic Inquiry 34, no. 4 (1996): 662-677.
25. Changes in uninsurance could also result from changes in underwriting practices or pricing strategies unrelated to provider payments and medical costs.
26. Our uninsurance variable is measured as an index (U.S. = 100), so its coefficients appear much larger than the others. These coefficients should not be interpreted as a change in uninsured risk; for example, 10 percent does not mean that the risk of being uninsured rose by ten percentage points. Hypothetically, if a state had the same uninsurance rate as the U.S. rate preconversion (for example, 15 percent), and the state's rate rose to 16.5 percent, then the change in the index would be 10 percent.
27. Medicare Payment Advisory Commission, Report to Congress: Medicare Payment Policy (Washington: MedPAC, March 2003), 39.
28. Ibid, 280.
29. Hall and Conover, "The Impact of Blue Cross Conversions.
30. Maryland Insurance Adminstration, Foundation Analysis: Final Report, 11 February 2003, www.mdinsurance.state.md.us/documents/LECGFinalReport2-11-03.pdf (17 December 2004).