A new study from the American Medical Association indicates thatthe number of metropolitan areas in which there’s little choice ofhealth care insurers is growing.

|

Healthcare Finance News reports that the 2017 edition of the AMA'sCompetition in Health Insurance: AComprehensive Study of U.S. Markets, which looked at market concentration in 2016, has found that in 43 percent of metropolitan areas (169 out of 389), a singlehealth insurer had captured at least a 50 percent market share—an 8percent increase in such concentrations in a little over twoyears.

|

According to the report, the study is “intended to helpresearchers, policymakers and regulators identify markets in whichconsolidation among health insurers may cause anti-competitive harmto patients and the physicians who care for them.” There’s lesscompetition among commercial health insurers in high marketconcentrations, which then exposes those markets to insurersflexing their muscles by boosting premiums above competitive levels.

|

The analysis, based on 2016 data on commercial enrollment infully and self-insured health maintenance organizations, preferredprovider organizations, point-of-service, public health exchangesand consumer-driven health plans, also provides a separateexamination of competition for predominant plan types, includingHMOs, PPOs, POS and the exchanges.

|

Sixty-nine percent of metropolitan areas exhibited a significantabsence of health insurer competition, and are rated “highlyconcentrated” based on federal guidelines used to assess the degreeof competition in a market. In 43 percent of metropolitan areas, asingle health insurer had at least a 50 percent share of thecommercial health insurance market, compared to 40 percent in 2014,with Anthem having the biggest geographic footprint in thecountry.

|

Anthem was also the largest health insurer by market share in 82of 389 metropolitan areas examined by the AMA. Health Care ServiceCorp. came in second, dominating market share in 42 metropolitanareas, with UnitedHealth Group coming in third, leading marketshare in 26 metropolitan areas.

|

According to the report, the 10 states with the leastcompetitive markets were Alabama, Delaware, Hawaii, South Carolina,Louisiana, Michigan, Kentucky, Vermont, Alaska and Illinois. The 10states that experienced the largest increase in marketconcentration were Kentucky, Alaska, South Carolina, Mississippi,South Dakota, Oklahoma, Vermont, Arkansas, Nevada and NewMexico.

|

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.