• Distribution of employer-sponsored health insurance enrollment by plan type

    Say what you will about the American Hospital Association (AHA), but they produce some really good charts in their annual Trends Affecting Hospitals and Health Systems. I could easily write dozens of posts based on the charts. In this one I’ll focus on how enrollment in different types of employer-sponsored health insurance plans has changed over time.

    There have been three significant developments over the last two decades. First, “conventional” or indemnity type plans all but disappeared between 1988 and the end of the 1990s. Second, as indemnity plans disappeared, PPOs arose in their place. (Actually, I’m guessing there was more enrollment in HMOs in the early- to mid-1990s–the era of managed care. That period is not shown in the graph.) Third, in recent years high deductible health plans (HDHPs) and savings option (SO) plans have emerged.

    Indemnity plans are now essentially dead. Among the remaining plan types HDHPs capture the least enrollment. That will likely change, but how quickly? And what will they replace?

    • Hmmm. Aaron’s OECD chart showed costs increasing from 1980-1992 and 2000-2008. They held fairly steady from 1992-2000. (All in terms of fraction of GDP) I had assumed this was partially due to managed care, but maybe the loss of indemnity plans was a factor in and of itself. Still not sure what would have made them rise so much in the 80s. New tech?


    • There is still more enrollment in HMOs even now. Many insurers view HMO as their main product. Especially, in West Coast (California).
      The growth of HDHP/SO is unlikely, due to the necessity to meet family deductible and family Out-of -pocket max; plus rapidly increased premium. It is necessary the absolutely new approach ER sponsored Health Benefits.