To enable high-risk individuals to have access to private health insurance, the Hong Kong government has announced the establishment of a high-risk pool reinsurance mechanism. Under the voluntary and government-regulated insurance program, “Health Protection Scheme”, the high-risk pool will accept individuals with pre-existing medical conditions or higher health risks. Critics have long expressed their concerns regarding the financial sustainability of Hong Kong’s healthcare system due to its heavy reliance on government subsidies and publicly funded services. Patients with pre-existing conditions are denied coverage by the private insurance sector, and have to rely heavily on the overburdened public healthcare system. Following the United States, the Hong Kong government suggests that a high-risk pool proposal will offer a relatively simpler approach compared to other alternatives. However, little is known about its applicability in Hong Kong or potential problems. Therefore, the objective of this study is to evaluate the effectiveness of high-risk pool in promoting healthcare efficiency, equity, and to make recommendations for the operations in Hong Kong. A systematic literature review was conducted on the MEDLINE database to study the overseas experience of high-risk insurance pools. Of the 52 articles included in the systematic review, the majority of the studies cover the operations in the United States. Results are analysed from the following eight perspectives. For efficiency, the studied areas include (1) fiscal sustainability, (2) adverse selection, (3) risk sharing and (4) cost containment. For equity, (5) insurance premium, (6) out-of-pocket expense, (7) enrolment barrier and (8) program awareness of the high-risk pools are analysed. Results of the systematic review show the inadequacies of the high-risk pool mechanisms in all of the above studied areas. In the United States, while industry assessment and government subsidization intend to facilitate risk sharing for high-risk population, insufficient funding and the industry’s deteriorated risk sharing capabilities undermine system efficiency. In addition, adverse selection and cost containment add to the already lengthy list of problems that high-risk pools have yet to address. Limited subsidies, high out-of-pocket payments, strict eligibility rules, and insufficient program awareness remain the four major barriers to health equity for the uninsurable. While studies on the overseas healthcare system have revealed several inadequacies regarding the high-risk pool mechanism, these uncertainties have to be resolved before Hong Kong can move forward to improve its healthcare efficiency and equity. More thoughts should be given on how the risk sharing capability can be enhanced within the insurance industry. Without a clear definition or a standardized underwriting rule that clearly defines “high-risk”, the high-risk pool could become a platform to practice adverse selection and further deteriorate the already limited risk sharing among the population. For addressing the issue of cost containment, the DRG charging system and chronic disease management programs are pivotal components to be incorporated. The government should perform a concrete assessment to justify how the spending on high-risk pool can essentially promote a more equitable system in Hong Kong. By considering the impact on both private insurance market and the public healthcare system, the government should further consider how to implement a high-risk pool that can effectively improve the healthcare efficiency and equity in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2006. / Includes bibliographical references (leaves 123-130).

Thesis (Ph.D.)--George Mason University, 2008. / Vita: p. 208. Thesis director: Roger Stough. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Policy. Title from PDF t.p. (viewed July 3, 2008). Includes bibliographical references (p. 196-207). Also issued in print.

Thesis (M.S.)--University of Wisconsin--Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 91-96).

Thesis (M.Nurs.)--Washington State University, May 2006. / Includes bibliographical references (p. 39-46).

Thesis (Ph. D.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on September 19, 2007) Vita. Includes bibliographical references.

No description available.

Thesis (Ph. D.)--Georgia State University, 2007. / Title from file title page. Mary Beth Walker, committee chair; Paul G. Farnham, Erdal Tekin, Patricia G. Ketsche, committee members. Electronic text (140 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed Dec. 31, 2007. Includes bibliographical references (p. 136-139).

Thesis (Ph. D.)--Brandeis University, 2008. / "UMI:3320136." Includes bibliographical references.

The theme of work is private health insurance. First is it described in the system of health insurance and then in the territory of Czech Republic. In the work is analyzed a new draft bill of Public health insurance and systems of health insurance in the Europe. Main goal of the thessis is to find suitable privat insurance product for Czech Republic.