Today, most current SARs tend to shift uncertainty about an expected outcome from healthcare payers to manufacturers. Although it is not possible to speak of risk sharing per man, manufacturers use it as an alternative to price reduction during negotiations. Some of these strategies could be used together. For example, reinsurance agreements could focus on groups with above-average costs, as relatively common and relatively expensive problems such as coronary heart disease or mental illness are more common. The separate pool of risks could be limited to exceptionally expensive people. Strategies to control or compensate for risk selection may make health insurance more affordable and accessible for many people at risk in the short term, but they will not make coverage more affordable on their own. By limiting the extent to which low-risk individuals can separate into separate risk groups, such strategies can increase costs for these individuals by pooling them with higher-risk groups, including groups that previously could not purchase insurance (GAO, 1991d). This broader consolidation could put health benefits out of reach for some low-income people. On the other hand, reducing the incentive for health care plans to compete on the basis of risk selection should promote competition based on effective management and other practices, and such competition could limit the overall cost of health benefits. Other consolidation approaches would work at the community level, not at the level of the individual employer. They would create a certification system for health schemes and purchasing cooperatives to streamline the procurement of health services on a state or regional basis.
Some proposals target the small group market; others would also cover large groups. Proposals whose main objective is the control of risk selection would generally not allow several cooperatives to operate in the same region and would discourage or prohibit coverage by non-certified health insurance schemes […].