An Efficiency-Based Approach to Determining Potential Cost Savings and Profit Targets for Health Insurers : the Case of Obamacare Health Insurance CO-OPs

This research analyzes the performance of the health insurance CO-OPs, examines their medical services and operating efficiency, and discusses an efficiency-based goal-oriented approach for potential cost reductions, premium changes, and government subsidies. Most CO-OPs suffer underwriting losses, so do many other insurers. The CO-OPs are not satisfactory in the medical services efficiency, and they are much less efficient compared with other insurers. Potential cost reductions are significant using various (conservative) efficiency goals. The operating efficiency generally is much better than the medical services efficiency, and a few CO-OPs are much more operating efficient than other insurers. Incorporating the potential cost reductions, many CO-OPs would hardly require any “premium changes and government subsidies” and they are even capable of paying back the federal loans. With both potential cost reductions and premium increases, more CO-OPs would not need any help from the government but survive on their own. It is important to realize that this research provides a guide for improvement potential. There may be reasons why a CO-OP cannot meet the efficiency targets