Originally posted by cdtm
I'm curious how we can make any assumptions at all about the cost of health care, when so much information is proprietary and transparency is closed to specialists who work at these hospitals. Blogs and articles exists of employees going down the rabbit hole to get solid information on costs, or at least factors
that go into it.. All futile.If we're taking information from administrators, how do we know they aren't lying? If from regulators, how do we know they aren't captured?
I'm sure they probably take data given to them by Kaiser studies or BC/BS review of services, actuarial studies (underwriters.)You can review part of the ACA that was reviewed by the CBO and they cite sources.
So for example perhaps Kaiser has a study that explains how different services affect premium values something like:
1 Doctor Office Copays, Specialist copays
2 Prescription Drug copay and formulary
3 Deductible
4 Coinsurance
5 Max out of pocket
6 Network access
First dollar benefits have a larger impact on monthly premiums by X amount due to the knowledge that those services will be used frequently and if a doctor bills 120 for an office visit and the copay is 10$ etc.
But those are good questions, no matter what group or pool that is being underwritten most actuaries are nervous about the performance of those groups due to 90/10 rule. 90 percent of premium dollars are normally paid to the highest 10% of the folks that use the services.