From 1998 to 2003, researchers at the Alpha Center for Health Planning compiled and analyzed data on the number and types of insurers in each state that provided health insurance policies directly to individuals or through employers or other groups.
They also identified changes occurring in each state's health insurance markets and documented the nature of the changes.
The Alpha Center was a Washington health policy research organization. It merged in 2000 with the Association for Health Services Research to form a new organization called AcademyHealth.
Among the researchers' key findings:
Nationally, the number of insurers offering health insurance directly to individuals or through employers and other groups decreased moderately between 1997 and 2001.
In some states, however, the number of insurers declined drastically, leaving the market for insurance at the local level concentrated in the hands of a few leading companies that had little incentive to compete with one another.
Many or all of the changes that occurred in market structure were independent of state regulation; however more "stringent" regulation sometimes had positive effects on the insurance market.
The effects of the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 on the small-group insurance market are likely to be mixed.