On the Suprisingly Low Cost of State Catastrophic Health Insurance Programs
研究了缅因、明尼苏达和罗德岛三州灾难性健康保险计划的实际成本远低于预期，并讨论了影响成本的可控因素及对联邦政策的警示。
Three states (Maine, Minnesota, and Rhode Island) have had programs to assist any resident in meeting uncovered expenses. The annual cost of these programs after 4-6 years of experience has been only a couple of dollars per state resident. A reasonable method of forecasting a priori the cost of such a program is shown to yield a much larger cost than actually has occurred. Some of the controllable factors affecting program growth (e.g., the deductible formula) are discussed, along with a variety of influences on the policy decisions at the state level. Finally, the paper warns against extrapolating the low cost of these state programs to federal initiatives in catastrophic coverage. Castastrophic health insurance (CHI) can be ideally defined as a guarantee that direct costs to eligible consumers for covered health services will be limited to a modest amount in relation to family resources. A variety of existing private and public programs approximate this essential criterion, while differing substantially in other dimensions. Within the private sector, contracts may vary in the type of services covered, the amount of cost sharing, and the choice of providers. A major This research was supported by HCFA grant # 18-P-97265/5/04 to the Center for Health Services and Policy Research. The authors thank Dr. Edward F.X. Hughes for helpful suggestions, Cathy Griffin, Ray Dow, and Harvey Zimmerman for data and insights on state programs. Anonymous referees for this Journal provided many useful criticisms and sugges-