How can the recipients of these programs be categorized into different risk pools? Explain.
Private vs. Public Control
The major payers in private healthcare (other than government programs) are employers, and this has been true since the inception of health insurance programs. There are several reasons why this is so, but one of the main reasons is employees are a defined risk pool based on the work performed for the company. Healthcare insurance companies are able to predict the financial risk (as in an experience rating) taken by the type of employees. If, for instance, the work is dangerous or injury prone, such as direct care in a nursing facility, then the cost to insure that group would be higher than for employees working at a telecommunications office. Government healthcare programs, such as Medicare and Medicaid, do not measure the cost of healthcare by the experience ratings.
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