The springboard for this sixth volume in the Industry and Health Care series was a conference sponsored by the Center for Industry and Health Care of Boston University on June 9 and 10, 1978. That conference had a gradual genesis. Over a year ago we spent some time with Kevin Stokeld of Deere and Company and heard his views on self-insurance and self-administration as one device for a corporation to achieve better management control of its health benefit. More recent discussions with representatives of American Telephone and Telegraph Company and other corporations made it increasingly clear to us that management's need for data to monitor the use of employee health benefits was emerging as a critical policy issue. Subsequent meetings with executives at John Hancock Mutual Life Insurance Company in Boston and Mobil Oil Corporation in New York, among others, convinced us that simple answers would be elusive or inadequate and that there was a need for an objective and careful look at the evolving relationships between employee health benefits, claims administration, health services utilization, and corpo rate health care cost containment programs. Since self-funding and particularly self-administration represent a fun damental change in the traditional insurance relationship, the conference was convened to explore the advantages and disadvantages of self-insurance for employee health benefits, with some attention to claims production but with special emphasis on the originating question of data for effective management of an employee health benefit.

The springboard for this sixth volume in the Industry and Health Care series was a conference sponsored by the Center for Industry and Health Care of Boston University on June 9 and 10, 1978. That conference had a gradual genesis. Over a year ago we spent some time with Kevin Stokeld of Deere and Company and heard his views on self-insurance and self-administration as one device for a corporation to achieve better management control of its health benefit. More recent discussions with representatives of American Telephone and Telegraph Company and other corporations made it increasingly clear to us that management's need for data to monitor the use of employee health benefits was emerging as a critical policy issue. Subsequent meetings with executives at John Hancock Mutual Life Insurance Company in Boston and Mobil Oil Corporation in New York, among others, convinced us that simple answers would be elusive or inadequate and that there was a need for an objective and careful look at the evolving relationships between employee health benefits, claims administration, health services utilization, and corpo rate health care cost containment programs. Since self-funding and particularly self-administration represent a fun damental change in the traditional insurance relationship, the conference was convened to explore the advantages and disadvantages of self-insurance for employee health benefits, with some attention to claims production but with special emphasis on the originating question of data for effective management of an employee health benefit.

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

How to Beat the High Cost of Health Care shows business owners how to save up to 50% on health care costs without cutting benefits. It can work for firms from one employee to 1,000. Learn why costs are going up, and why it's important to have a unique strategy tailored to your own company. Discussion why the "Total Benefits" strategy is better than a health savings account. A step-by-step illustration of the "Total Benefits" strategy provides instructions on how to not let soaring health care costs threaten your organization's financial security. Detailed tax code resources provide invaluable reference for those implementing the "Total Benefits" strategy. If you think it costs too much to stay healthy--you're right--it does cost too much! The good news is that it doesn't have to--if you have a better strategy. Take a look, and see how it can work for you!

This paper examines recent trends in self-insurance. Data come from the Medical Expenditure Panel Survey (MEPS) and are presented by establishment size among private-sector employers. State-level data are also presented, along with the correlation between state mandates and the prevalence of self-insurance. Offering a self-insured plan means the employer assumes the financial risk related to offering health insurance (as opposed to a fully insured plan, where the insurance company assumes the risk). Large employers are much more likely to offer health benefits on a self-insured basis than small employers. However, there is speculation that passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) will result in an increasing number of smaller employers offering self-insured plans. Employers think that components of PPACA, such as the strict grandfathering requirements; the minimum-creditable-coverage requirement; the breadth of essential health benefits; taxes on insurers, medical-device manufacturers, and pharmaceutical companies; affordability requirements; and reinsurance fees will all drive up the cost of health coverage. Small employers concerned about the rising cost of providing health coverage may view self-insurance as a more attractive means to mitigate any expected cost increases. Some key findings include the following: The percentage of workers in private-sector self-insured health plans has been increasing. In 2011, 58.5 percent of workers with health coverage were in self-insured plans, up from 40.9 percent in 1998. Large employers (with 1,000 or more workers) have driven the upward trend in overall self-insurance. The percentage of workers in self-insured plans in firms with fewer than 50 employees has been close to 12 percent in most years examined. The prevalence in self-insured plans varies by state, with Massachusetts having the third-highest prevalence of self-insurance in the small-group market (behind Hawaii and Alaska). Overall, 58.5 percent of workers were in self-insured plans in 2011, but the percentage ranged by state, from a low of 30.5 percent to a high of 73.8 percent. Massachusetts, the only state to have enacted health reform similar to PPACA, has seen an increase in the percentage of workers in self-insured plans among all firm-size cohorts, except among workers in firms with fewer than 50 employees. The PDF for the above title, published in the November 2012 issue of EBRI Notes, also contains the fulltext of another November 2012 EBRI Notes article abstracted on SSRN: “All or Nothing? An Expanded Perspective on Retirement Readiness.”