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Restraining the Health Care Consumer

The History of Deductibles and Co-payments in U.S. Health Insurance

Published online by Cambridge University Press:  04 January 2016

Beatrix Hoffman
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Abstract

Health insurance with high deductibles is an important feature of the Bush administration's health savings accounts initiative. A similar type of insurance, known as major medical, was the most common type of health coverage in the United States from the 1950s through the 1970s. This article traces the history of cost sharing in health insurance from its origins in insurers' concerns about “moral hazard” to the heyday of major medical insurance to the temporary comeback of first-dollar coverage during the era of managed care. Proponents of deductibles and co-payments, today and in the past, have argued that they bring down costs by forcing consumers to make more careful health care choices. The history of major medical insurance, however, shows that high-deductible insurance failed to curb medical inflation and also hurt consumers who expected their coverage to protect their incomes from the costs of sickness and injury.

Type
Articles
Information
Social Science History , Volume 30 , Issue 4: The Persistence of the Health Insurance Dilemma , Winter 2006 , pp. 501 - 528
Copyright
Copyright © Social Science History Association 2006 

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