Health insurance small employers

The U.S. is unique among advanced nations in that it has resisted the implementation of a system of imiversal health care and instead has gradually built a system in which employers are the primary sponsors of health care coverage for the majority of the population. Medicare and Medicaid cover the elderly, disabled, and very poor. According to data from the U.S. Census Bureau, a small proportion of people, less than 7% of the population under 65 years of age, purchase health insurance on their own. In 2002, the remaining 41 million persons were uninsured. The uninsured represent 14.6% of the total population, 16.5% of the population under 65 years. Those with adequate resources pay out of their pockets for health care. The others go without care, delay care, or seek health services from a fragile and incomplete system of charity care and safety-net providers. 

It is not even clear if size of operation in itself is related to hazard management and the incidence of occupational trauma. A study of explicit and implicit risk pooling of small employers in the US workers compensation insurance market, based on the 1987 National Medical Expenditure Survey, found little support for the hypothesis that employees and dependents of small firms are likely to be averse to health risks should they obtain coverage comparable to that held by large-firm employees (Monheit Vistnes, 1994). 

Morrisey, MA, Jensen, GA, Morlock, RJ (1994) Small Employers and the Health Insurance Market. Health Affairs, 13 (5) 149-61. 

Without exception, all industries and companies face safety and health issues, which could have adverse effects upon their workforce and workplace. It does not matter whether you are a service industry, insurance agency, construction operation, or manufacturer of widgets. Your workforce will be exposed to the hazards unique to that worksite. It is definitely beneficial to your bottom line to not have any of your workforces injured or ill from something within your place of employment. Whether you are large or small having anyone in your workforce who has been incapacitated in any way disrupts the work process. Not counting the loss of a potential key employee, the time spent addressing an incident that has caused injuries or illnesses definitely cuts into the bottom line. If you think this is bad, you have no idea about the impact of occupationally related deaths. 

This simple business model became untenable, as the expensive-to-treat diseases drove many households bankrupt. Fortunately, the fact that such diseases afflicted only a small portion of the population enabled incorporation of risk sharing in the business model through 3rd party insurance companies. Today, the major stakeholders in the healthcare system include providers (hospitals, labs, and clinics), insurance companies with a diverse set of health plans, drug suppliers (retailers and manufacturers), medical device manufacturers, payers (employers and the government), research institutions, and patients as shown in Fig. 10.1. 

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