Access to coverage for high-risks in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted premium subsidies?

J Health Econ. 2000 May;19(3):311-39. doi: 10.1016/s0167-6296(99)00028-4.


A competitive market for individual health insurance tends to risk-adjusted premiums. Premium rate restrictions are often considered a tool to increase access to coverage for high-risk individuals in such a market. However, such regulation induces selection which may have several adverse effects. As an alternative approach we consider risk-adjusted premium subsidies. Empirical results of simulated premium models and subsidy formulae are presented. It is shown that sufficiently adjusted subsidies eliminate the need for premium rate restrictions and consequently avoid their adverse effects. Therefore, the subsidy approach is the preferred strategy to increase access to coverage for high-risk individuals.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Economic Competition*
  • Fees and Charges* / statistics & numerical data
  • Financing, Government*
  • Insurance Coverage / economics*
  • Insurance, Health / economics*
  • Risk Adjustment*