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Liability insurance: can hospitals afford a roll of the dice?

The rise in hospital malpractice claims has greatly affected hospital liability insurance. Increasing premium costs and the shrinking availability of coverage have been some of the effects hospitals have felt. The two most promising approaches for dealing with this problem are increased risk management and changes in tort law. These solutions allow insurance companies to calculate the risk, leading to greater predictability.

Costs and Cost Analysis↗

The marginal effect of bond insurance on hospital, tax-exempt bond yields.

In response to changes in the health care environment and the tax-exempt bond market, many hospitals have purchased bond insurance and other forms of credit enhancement to lower the yields on their debt financings. This study of tax-exempt revenue bonds issued by hospitals from 1982-84 estimates that bond insurance lowers yields on hospital bonds by approximately 87 basis points and that bond insurance serves as a substitute measure of creditworthiness. The findings also suggest that the insured group of hospital bonds is more homogeneous than the uninsured group in terms of characteristics that affect the risks associated with hospital investments. Insured bonds seem to represent hospitals in an intermediate risk group.

Capital Financing↗

Nonprofit to for-profit conversions by hospitals, health insurers, and health plans.

Conversion of hospitals, health insurers, and health plans from nonprofit to for-profit ownership has become a focus of national debate. The author examines why nonprofit ownership has been dominant in the US health system and assesses the strength of the argument that nonprofits provide community benefits that would be threatened by for-profit conversion. The author concludes that many of the specific community benefits offered by nonprofits, such as care for the poor, could be maintained or replaced by adequate funding of public programs and that quality and fairness in treatment can be better assured through clear standards of care and adequate monitoring systems. As health care becomes increasingly commercialized, the most difficult parts of nonprofits' historic mission to preserve are the community orientation, leadership role, and innovation that nonprofit hospitals and health plans have provided out of their commitment to a community beyond those to whom they sell services.

Community-Institutional Relations↗

Medicare financing reform: a new Medicare premium.

The original and continuing promise of Medicare can be preserved only through a complex package of fiscal reforms. Central to this should be a merger of Hospital Insurance and Supplementary Medical Insurance into a single Medicare trust fund, financed in part through income-related beneficiary premiums. Benefits could be expanded, while improving access and equity.

Cost Control↗

Hospital helps insure more children.

Marquette General Hospital's involvement in an initiative to insure children has brought local credibility to a nationwide program and added strength to the hospital's mission.

Child↗

Private health insurance plans in 1977: coverage, enrollment, and financial experience.

The private health insurance industry collected $47.1 billion in premiums in 1977 and returned $41.6 billion in benefits to their subscribers. Premiums rose 16.3 percent as a direct consequence of rapid claims growth in 1976. After operating expenses were deducted, the industry showed a small, $.4 billion underwriting loss. About 78 percent of the population were insured for hospital care, and about 76 percent for surgical services. Smaller percentages had coverage for other types of care. An estimated 61.8 percent of the aged bought private hospital insurance, and 47.1 percent bought surgical insurance, mostly to supplement Medicare benefits. About 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.

Data Collection↗

Private health insurance plans in 1978 and 1979: a review of coverage, enrollment, and financial experience.

The private health insurance industry collected $55.9 billion in premiums in 1979 and returned $50.2 billion in benefits to its subscribers. Premiums rose 12.4 percent, slightly faster than in 1978 when premiums rose 11.4 percent, to $49.7 billion. Benefits rose 11.4 percent in 1979, down from the 12.6 rate in 1978. After operating expenses were deducted, the industry showed underwriting losses of $1.4 billion in 1979 and $1.5 billion in 1978. About 78 percent of the population was insured for hospital care, 76 percent for x-ray and laboratory examinations, and about 76 percent for surgical services in 1979. Smaller percentages had coverage for other types of care. An estimated 64 percent of the aged bought private hospital insurance, and about 43 percent bought surgical insurance, mostly to supplement Medicare benefits. An estimated 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.

Insurance↗