Employer-based health insurance in a changing work force.

The loss of manufacturing jobs and the expansion of service jobs and part-time employment have contributed to a decline in the rate of employer-sponsored health insurance among workers. Not only does manufacturing provide more of its own workers with coverage compared with other industry groups, but it also is a significant net "exporter" of coverage to dependent workers in other industries. In 1991 the net export of coverage represented a 20 percent tax on manufacturing employers per covered worker, while professional services--the fastest-growing industry group-collected a subsidy from other industry groups equal to more than 12 percent per covered worker. Similarly, larger firms--those that employed 100 workers or more--paid a self-imposed tax of as much as 13 percent per covered worker to support dependent workers employed in smaller firms.

Opportunity wages and workforce adjustments: understanding the cost of in-home elder care.

Time spent providing informal care represents a real cost to caregivers and potentially affects their decisions about alternative activities, including paid work. This study offers estimates of opportunity wages incurred by informal caregivers and explores the impact of these costs on their decisions to reduce or abandon workforce participation. We consider caregivers at two points in time: 1982 and 1989. Our estimates of caregivers' imputed wages vary more widely and range higher than those reported elsewhere, varying from $0.78 to $27.18 per hour, compared to values in the literature ranging from $4.64 to $10.30. In both years, caregivers with higher imputed wages were significantly more likely to work, with this effect stronger in 1989 as all noneconomic factors became less important. However, accommodation (working fewer hours or foregoing job opportunities) decreased with higher imputed wages in 1982 only. In 1989, elders' frailty became a significant determinant of accommodation.

Redefining private insurance in a changing market structure.

This discussion on likely changes and challenges for the health insurance industry over the coming decade assumes that significant national reform of health care financing for the privately insured population will not occur--or, if it does, that it will mirror the insurance market reforms that many states already have undertaken. First, the changes in private insurance coverage during the past several years are considered, with particular attention to the erosion of employer-based coverage and to the rising influence of public insurance programs--especially Medicaid--on the private insurance market. Next is a description of the changing web of state laws and regulations governing private health insurance. At this writing, virtually every state has enacted or is considering reforms of the small group market to limit what many perceive as unfair or destructive insurer practices and to set new ground rules for competition among insurance arrangements. The changing nature of private insurance contracts in the United States is considered next. Evolving from conventional fee-for-service contracts, private insurance is increasingly a complex mixture of capitation, partial capitation, and reinsurance of capitated arrangements. Finally, this chapter discusses three issues of increasing importance in shaping the marketplace for private insurers: (1) the federal preemption of states' regulatory authority over self-insured employer plans; (2) emerging state regulation to restructure competition in the health insurance and health care markets; and (3) the growing interest of both federal and state governments in medical savings accounts to finance health insurance and health care spending.