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Competitive bidding for health insurance contracts.

G M Keijser¹, B L Kirkman-Liff

¹School of Health Administration and Policy, Arizona State University, Tempe 85287.

Health Policy (Amsterdam, Netherlands)

|April 8, 1992

Summary

Competitive bidding offers a superior alternative to risk-adjusted payments for health insurer reimbursement. This market-based approach effectively lowers healthcare costs and encourages innovation, outperforming traditional regulatory systems.

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Area of Science:

Health economics
Healthcare management
Health insurance policy

Background:

Accurate determination of health insurance premiums is crucial for large purchasers of care.
Risk-adjusted payments, while common, present significant challenges in accurately reflecting enrolled persons' risk.
Existing regulatory systems for health insurer payment may not be optimally efficient or equitable.

Purpose of the Study:

To evaluate competitive bidding as a viable alternative to risk-adjusted payment models in health insurance.
To assess the effectiveness of competitive contracting in controlling healthcare costs.
To explore the potential of competitive bidding to foster innovation and cost containment.

Main Methods:

Analysis of research data from the U.S. on competitive contracting in healthcare.
Comparison of outcomes between area-specific bidding and state-wide payment systems.
Examination of market forces' impact on provider bids and service quality.

Main Results:

Competitive contracting demonstrated effectiveness in lowering healthcare costs in studied sectors.
Area-specific bidding yielded more equitable results compared to state-wide systems with crude adjustments.
Competitive bidding creates incentives for innovation and cost-containment.

Conclusions:

Competitive bidding presents a strong alternative to traditional risk-adjusted payment systems for health insurers.
This model allows for consideration of local variations in healthcare supply and demand.
Regional experimentation with competitive bidding for health insurer payment is recommended.