Some Facts On Insurance Pools

  • Most of the claim dollars are used by a small subset of the insured population.
  • In a normal insured population, if we ordered the highest cost people to the lowest, we would find that the sickest (highest cost) 5% of the population uses almost 57% of the claim dollars1.
  • The healthiest 70% use approximately 7% of the claim dollars1.

1Verisk Healthcare norms and other sources

The Impact Of Lifestyle Choices

  • Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, cost, and early death related to chronic diseases.
  • A 10% drop in cholesterol levels is projected1 to cut the incidence of heart disease by 30%, an estimated annual savings of almost $43 billion nationally.

1National Governors Association. NGA Report on Healthy Living. Investing in America's Health. Washington, DC: NGA, 2007.

Other Healthcare Cost Drivers

  • Age and gender are major drivers of demand for healthcare services which drives cost.
  • Young male adults are the least expensive risks to an insurer.
  • Older males are the most expensive risks.
  • Females are more expensive than males in the child-bearing years and then develop a gradual advantage over males of the same age.
  • As we age, we become more susceptible to chronic disease driven by our genetics or poor lifestyle choices.
Where are the Claim Dollars Spent?

Where are the Claim Dollars Spent?

Source: Mississippi: Burden of Chronic Diseases – Center for Disease Control published 2008

*Compared to age 19 to 34 year old males

Source: Actuarial Advisor Healthcare Cost Model from Windsor Strategy Partners