How to deal with persistently low/high spenders in health plan payment systems?
Health Econ
; 31(5): 784-805, 2022 05.
Article
en En
| MEDLINE
| ID: mdl-35137476
Health insurance markets with community-rated premiums typically include risk adjustment (RA) to mitigate selection problems. Over the past decades, RA systems have evolved from simple demographic models to sophisticated morbidity-based models. Even the most sophisticated models, however, tend to overcompensate people with persistently low spending and undercompensate those with persistently high spending. This paper compares three methods that exploit spending-level persistence for improving health plan payment systems: (1) implementation of spending-based risk adjustors, (2) implementation of high-risk pooling for people with multiple-year high spending, and (3) indirect use of spending persistence via constrained regression. Based on incentive measures for risk selection and cost control, we conclude that a combination of the last two options can substantially outperform the first, which is currently used in the health plan payment system in the Netherlands.
Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Gastos en Salud
/
Seguro de Salud
Tipo de estudio:
Etiology_studies
Límite:
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Health Econ
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2022
Tipo del documento:
Article
País de afiliación:
Países Bajos