Effect of Ambulatory Surgery Policy Provisions on Medical Expense Insurance Claims

Since the early 1980s insurers have offered medical expense insurance policies designed to reduce claim costs by providing incentives to insureds to use outpatient rather than inpatient surgery. Substitution is encouraged through the policy costsharing structure, where the insured's copayment f...

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Bibliographic Details
Published in:The Journal of risk and insurance 1990-12, Vol.57 (4), p.608-622
Main Author: Doerpinghaus, Helen I.
Format: Article
Language:English
Subjects:
Ambulatory care
Ambulatory surgical procedures
Claims adjustment (Insurance)
Cost reduction
Cost sharing
Costs
Economic aspects
Effectiveness
Employer provided health insurance
Finance
Health care costs
Health insurance
Health insurance claims
Incentives
Insurance deductibles
Insurance expenses
Insurance industry
Insurance policies
Insurance providers
Interpretation and construction
Medical expense insurance
Statistical analysis
Surgery
Surgery, Outpatient
Surgical specialties
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Summary:Since the early 1980s insurers have offered medical expense insurance policies designed to reduce claim costs by providing incentives to insureds to use outpatient rather than inpatient surgery. Substitution is encouraged through the policy costsharing structure, where the insured's copayment for inpatient surgery is greater than that for outpatient surgery. This study investigates the effectiveness of policy design in inducing surgical substitution and reducing claim costs. Empirical evidence on claims data for 197,911 insureds suggests that policies designed to encourage use of ambulatory surgery do not induce the substitution of outpatient for inpatient surgery and insurer claim costs are not reduced.
ISSN:0022-4367
1539-6975
DOI:10.2307/252946