Selection Incentives in the Dutch Basic Health Insurance: To What Extent Does End-of-Life Spending Contribute to Predictable Profits and Losses for Selective Groups?
Med Care Res Rev
; 79(6): 819-833, 2022 Dec.
Article
em En
| MEDLINE
| ID: mdl-35677989
ABSTRACT
Existing risk-equalization models in individual health insurance markets with premium-rate restrictions do not completely compensate insurers for predictable profits/losses, confronting insurers with risk selection incentives. To guide further improvement of risk-equalization models, it is important to obtain insight into the drivers of remaining predictable profits/losses. This article studies a specific potential driver end-of-life spending (defined here as spending in the last 1-5 years of life). Using administrative (N = 16.9 m) and health survey (N = 384 k) data from the Netherlands, we examine the extent to which end-of-life spending contributes to predictable profits/losses for selective groups. We do so by simulating the predictable profits/losses for these groups with and without end-of-life spending while correcting for the overall spending difference between these two situations. Our main finding is that-even under a sophisticated risk-equalization model-end-of-life spending can contribute to predictable losses for specific chronic conditions.
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Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
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Estado_mercado_regulacao
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Risco Ajustado
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Motivação
Tipo de estudo:
Etiology_studies
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Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Med Care Res Rev
Assunto da revista:
PESQUISA EM SERVICOS DE SAUDE
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Holanda