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Policy makers are interested in how many employer health plans are self-insured and in identifying forces that lead to change. This article reports on findings from the 1993 and 1997 Robert Wood Johnson Foundation Employer Health Insurance Surveys. The percent of businesses self-insuring fell over this period at all size levels, but the change was largest for small employers. The decline seems to be related to growing opportunities to take advantage of the lower costs offered by HMOs. Recent changes in state insurance regulation do not appear to have affected the choice to self-insure.

Originally published in: Health Affairs, v. 18, no. 3, June 1999, pp. 161-166.

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