Market failure in long-term private health insurance markets: a proposed solution

Recently, private health insurance rates have declined in many countries. In places requiring community rating in their health insurance premiums, a major cause is age-based adverse selection. However, even in countries without community rating, a de facto type of partial community rating tends to occur. In this note, a modified version of Pauly et al.'s guaranteed renewability model, which addresses the problem of age-based adverse selection (Pauly et al., 1995) is presented. Their model is extended from three to 35 periods. Also, probabilities are allowed to increase by age for low-risk types using actual age-based probabilities. This extension of their work shows that private health insurance contracts available stray far from optimal contracts that deal with age-based adverse selection. This suggests that government actions to affect private insurance options are warranted.

Lifetime cover in private insurance markets

In the last few decades, private health insurance rates have declined in many countries. In countries and states with community rating, a major cause is adverse selection. In order to address age-based adverse selection, Australia has recently begun a novel approach which imposes stiff penalties for buying private insurance later in life, when expected costs are higher. In this paper, we analyze Australiarsquos Lifetime Cover in the context of a modified version of the Rothschild-Stiglitz insurance model (Rothschild and Stiglitz, 1976). We allow empirically-based probabilities to increase by age for low-risk types. The model highlights the shortcomings of the Australian plan. Based on empirically-based probabilities of illness, we predict that Lifetime Cover will not arrest adverse selection. The model has many policy implications for government regulation encouraging long-term health coverage.

Warehouse, PNG Coffee Industry Board Office and Warehouse, Goroka

View of exterior wall to warehouse.

Downpipes, PNG Coffee Industry Board Office and Warehouse, Goroka

Detailed view of downpipes and drainage grill.

PNG Coffee Industry Board Office and Warehouse, Goroka

View past tiered amphitheatre and offices above to air strip beyond.

View along western elevation, PNG Coffee Industry Board Office and Warehouse, Goroka

View past timber blinds to balcony and timber sunscreens.

Under construction, PNG Coffee Industry Board Office and Warehouse, Goroka

View of post being hoisted into position during construction.

Warehouse, PNG Coffee Industry Board Office and Warehouse, Goroka

View of warehouse exterior.

Pole detail, PNG Coffee Industry Board Office and Warehouse, Goroka

Detailed view of poles used in construction. Poles were spliced in their length with steel bars (like 3 pin plugs) and these joints were restrained from splitting with steel strap belts. The belts were tightened with opposing wedges like the old Greene & Greene wrought iron detail.

Warehouse, PNG Coffee Industry Board Office and Warehouse, Goroka

View of warehouse exterior.

Roof structure, internal, PNG Coffee Industry Board Office and Warehouse, Goroka

View to underside of roof with steel beam and insulation.

Post and beam connection, PNG Coffee Industry Board Office and Warehouse, Goroka

Detailed view of cast iron brackets connecting beams and posts.

Front elevation, PNG Coffee Industry Board Office and Warehouse, Goroka

View of front elevation with entrance from exterior.

Post and beam connection, PNG Coffee Industry Board Office and Warehouse, Goroka

Detailed view of cast iron brackets connecting beams and posts.