Health Insurance Blog

There have been several articles published within the last week, most notably in the New York Times regarding health insurance rates paid by women compared to rates paid by men.  The article used health insurance quote data gathered from such health insurance companies as Humana, Aetna, and Wellpoint as well as online health insurance marketplace ehealthinsurance.com, and state high-risk pools.

The article in the New York Times sites several examples of price discrepancies between women and men of similar ages for identical coverage levels at various health insurance companies.  The data is rather compelling as the health insurance rate differences are in the 30-50% range.  However, does anyone really believe that health insurance companies are unfairly setting rates artificially high for women?

The article mentions the comparatively high health care expenses for women during child bearing years, but later dispels this as the sole explanation siting that the wide range in premiums couldn’t possibly be justified by actuarial analysis.

It would have been a more compelling analysis, and further solidified the argument if the author went on to compare health insurance rates for a 60 year old man vs women, an age when men’s health issues become more prominent.

After a quick analysis comparing rates on ehealthinsurance.com, an elderly man can expect to pay about 5% more than an elderly women for identical coverage levels.  The results of this quick test were not quite the results that I was looking for that would invalidate the argument that women are being gouged on their health insurance rates.  But my gut feeling tells me that the disparity between a women’s and men’s expected health care costs in their mid 30s, for example, are indeed magnitudes apart, and health insurance  companies are appropriately planning for potential claims.

The department of insurance (DOI) in each state must approve health insurance premiums based on claims history, and actuarial analysis, and would not approve rates if the this analysis didn’t support the rates  they requested.

Anthem Blue Cross Blue Shield of Indiana (a subsidiary of Wellpoint) announced an incentive program for physicians in their network which could increase their reimbursements by 10% if they follow recommended care guidelines.

Bonuses that physicians would be eligible for would be based their relative ranking when comparing the health status of their patients to others in the region.

The effectiveness that this program will have on improving care for Indiana residents is yet to be determined.

More information about Indiana health insurance, and a listing of top carriers who provide individual health insurance plans to Indiana residents.

Medical tourism is a practice that has become more common over the past year, and some health insurance companies are now starting to get on-board with the practice and actually paying bonuses to members who agree to get procedures done in this way.

In short, Medical tourism is the practice of traveling overseas to have medical procedures or surgeries done in order to save money.  Over 50 countries have now identified medical tourism as a national industry.

Some health plans are beginning to cover procedures such as heart surgeries, hip/knee replacement and other pricey procedures due to the money that they can save.  For example, open heart surgery in the U.S might cost $100,000, but at an accredited hospital in India, the same procedure might cost only $8,500.

As you can see, the economic advantages of medical tourism are clear, but is it safe?

A recent UCLA study compared 33 patients who had kidney transplant surgery overseas vs. 66 who had the same procedure done here in the United States, at the UCLA hospital.  The study found that 30% of patients who had the procedure done overseas had kidney rejection vs. 12% for those treated at UCLA.  In addition, the rate at which patients needed to be hospitalized due to infection was 3 times higher with the overseas patients.

You can see why medical tourism would be a controversial process for health insurance companies to get involved with.  Nevertheless, Blue Cross Blue Shield of South Carolina (BCBSSC) has created a subsidiary for medical tourism that maintains an international network of doctors and hospitals covering Thailand, Costa Rica, Ireland, Turkey and other destinations.  In addition, Anthem Blue Cross & Blue Shield, will roll out a medical-travel benefit with one of the employer groups they cover in January of 2009.