Title

Impact Of Medical Loss Regulation On The Financial Performance Of Health Insurers

Authors

Authors

M. McCue; M. Hall;X. L. Liu

Comments

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Abbreviated Journal Title

Health Aff.

Keywords

LOSS RATIO; Health Care Sciences & Services; Health Policy & Services

Abstract

The Affordable Care Act's regulation of medical loss ratios requires health insurers to use at least 80-85 percent of the premiums they collect for direct medical expenses (care delivery) or for efforts to improve the quality of care. To gauge this rule's effect on insurers' financial performance, we measured changes between 2010 and 2011 in key financial ratios reflecting insurers' operating profits, administrative costs, and medical claims. We found that the largest changes occurred in the individual market, where for-profit insurers reduced their median administrative cost ratio and operating margin by more than two percentage points each, resulting in a seven-percentage-point increase in their median medical loss ratio. Financial ratios changed much less for insurers in the small-and large-group markets.

Journal Title

Health Affairs

Volume

32

Issue/Number

9

Publication Date

1-1-2013

Document Type

Article

Language

English

First Page

1546

Last Page

1551

WOS Identifier

WOS:000324681500006

ISSN

0278-2715

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