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------=_NextPart_01C66E98.1E811C20 Content-Location: file:///C:/4D28C652/PhilOConnor_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C66E98.1E811C20 Content-Location: file:///C:/4D28C652/PhilOConnor_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE ILLINOIS COMPETITIVE MODEL
THE ILLINOIS COMPETITIVE MODEL &a= mp; HEALTH INSURANCE SINCE 1= 965
ADEQUATE HEALTH CARE TASK FORCE MEETING
April = 21, 2006   Chicago
Philip R. O’Connor, Ph.D.
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HEALTH INSURANCE: CHANGING MARKET SH= ARES
•The story of health insurance and coverage of health care costs is one of = rapidly changing “market shares.”
•Public policy choices, demographics, economic growth, technological change & complex financial markets have made the idea of health insurance a moving target.
•Health insurance and health care are different products than they were in 1965.
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HEALTH C= ARE FUNDING
        = ;          1965   vs.    2005
•Share GDP         6% 16%
•Sources
–Out-of-Pocket 43% 15%  
–Third Party 57% 85%
–
–Private          74% 55%
–Public          26%         = ;          45%
•State 14% 13%
•Federal 12% 32%
•
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PRIVATE INSURANCE VS.
PUBLIC FUNDING
•In 1965 private heal= th insurance and public funding of health care each had <= span style=3D'position:absolute;top:38.5%;left:9.73%;width:87.26%;height:6.75%'= >comparable market shares of ≥ 26%. •In 2005 health insurance had about a 40% share compared to government’s 45%. •From 1965 to 2005, t= he private out-of-pocket share fell from 43% to 15%.
•
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WHAT WE ARE BUYING
        = ;          1980  vs.  2000
•Hospital Care   47%       36% <= /span>
•Prof. Services 27% <= /span>      29% <= /span>
•Dental    6% 5%
•Home Health         = ;   1% 3%
•Prescrip. Drugs       6%<= span style=3D'mso-tab-count:2;width:12.15%'>       11% <= /span>
•Nursing Home    8% 8%
•Other personal    1% 3%
•Medical products    6% 4%
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OTHER BIG MARKET SHARE TENSIONS=
•Fee for Service   vs.  Capitation
•Managed Care    vs.  Non-contract pricing <= /div>
•Risk/Indemnity    vs.  “Self-Insurance” =
•Guarantee Issue vs.  Underwriting
•Hospitalization    vs.   Outpatient
•Full Service       vs.<= span style=3D'mso-spacerun:yes'>   Specialized Settings
•Compensation    vs.   Employee Benefits
•Full Coverage     vs.   Catastrophic
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ILLINOIS POLICY CHOICES IN HEALTH INSURANCE
•<= /span>Late 70s – Early 80s: Promotion of managed <= /span>care options, HMOs.
•<= /span>1983: Exiting Blue Cross rate regulation and = mutualization of HCSC
•<= /span>Encouragement of cost control regimes. =
•<= /span>Mandated benefits in state regulated forms
•<= /span>1987: CHIPS – high risk coverage =
•<= /span>90s: Portability/Pre-existing condition legislatio= n
•<= /span>Periodic policy reviews & task forces.
•<= /span>Competition as a price regulator
•<= /span>
•
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INSURANCE PRICE COMPETITION IN ILLI= NOIS
•Illinois has opted f= or an anti-trust model on pricing under the 1945 Federal delegation of insurance regulation to the states •Each property/casualty, health and life insurance company or commo= nly owned group must make its own individual decisions about pricing. •Insurers can use advisory groups to collect loss data but bureaus cannot prepare advisory rates. 
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RESEARCH & EXPERIENCE SUPPORT COMPEITIVE
•Research by academics and insurance = = regulators almost uniformly finds that rate regulation does not produce any benefits = beyond those of competitive pricing. <= span style=3D'font-size:88%'>•The research supports the contention that <= /span>competitive pricing is more efficient and likely t= o = produce a more consumer friendly environment.  = •Illinois regulators and legislators have adhered <= /span>to competition due to superior results.
<= span style=3D'font-size:88%;visibility:hidden'>•
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EXAMPLE: AUTO INSURANCE PRICE REGULATION INFERIOR
•<= /span>In Auto Insurance, Rate Regulation States
–<= /span>Are the dozen highest priced for auto insurance &#= 13;
–<= /span>Have rates no lower on average =
–Have higher exit and lower insurer entry rates = ;
–<= /span>Have larger personal lines residual pools
–<= /span>Have more volatile auto loss ratios
–<= /span>Have larger residual cross-subsidies
–<= /span>Have larger voluntary market cross-subsidies <= /span>
–<= /span>Have less accurate prices
–<= /span>Make price changes political events, not economic&= #13;
–<= /span>Rob regulatory resources from more vital needs = ;
•
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ILLINOIS APPROACH HAS ENCOURA= GED INNOVATION
•All health insurance policy forms must meet minimum statutory and regulatory standards. •Life and = Health policy forms must have prior approval to assure compliance. •Department tends to be more open than closed minded on new products offerin= gs and respects diversity in products.
<= span style=3D'visibility:hidden'>•
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ILLINOIS HAS EMPHASIZED CONSUM= ER PROTECTION OVER PRICE REGULATION
•<= /span>Illinois became a national leader because it could devote resources to market conduct = exams modeled on financial exams.
•Market conduct exams focus on patterns and = = practices to better assure broad fairness.
•<= /span>Illinois has relied on information disclosure and = <= span style=3D'font-size:88%'>was an innovator in designing system to handle = handle consumer complaints.
•<= /span>Annual consumer complaint ratios allow = customers to compare insurers. <= /div>
•
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RESOURCES ARE DIRECTED AT MORE IMPORTANT MATTERS
•Virtually = every innovation in the past 30 years has started in Illinois:
–&= #8220;Early warning” financial ratio analysis;
–<= span style=3D'mso-spacerun:yes'> CPA audit rule <= /div>
–T= argeted financial exams
–<= span style=3D'mso-spacerun:yes'> Risk Based Capital reports
•Focus on financial solvency regulation has helped to instill a culture of professionalism in = the Insurance Department.
•
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ECONOMIC RESULTS OF THE ILLINOIS= MODEL
•<= /span>Personal & business consumers can usually find needed and desired cover= age at prices that compare favorably nationally.
•<= /span>Hard markets tend to correct rather quickly. <= /span>
•<= /span>Prices convey accurate assessment of risk.
•<= /span>Illinois is attractive as an insurer home base and= consequent employment results. <= /div>
•<= /span>State with the highest percentage share of auto an= d homeowners insurers licensed in the US.
•<= /span>State policymakers have sent a signal that politic= s will not distort economics of the insurance market.
•<= /span>
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