Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets

Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets

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  • Author: Thomas G. McGuire
  • Publisher: Academic Press
  • ISBN: 012811326X
  • Category : Business & Economics
  • Languages : en
  • Pages : 648

Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness


State Health Insurance Market Reform

State Health Insurance Market Reform

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  • Author: Joel C. Cantor
  • Publisher: Routledge
  • ISBN: 0415651956
  • Category : Business & Economics
  • Languages : en
  • Pages : 193

In this volume, leading American health economists provide a critical assessment of the current state of knowledge of insurance market reform that is accessible to both policy-makers and researchers.


Models of Health Plan Payment and Quality Reporting

Models of Health Plan Payment and Quality Reporting

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  • Author: Jacob Glazer
  • Publisher: World Scientific Publishing Company
  • ISBN: 9813202882
  • Category : Business & Economics
  • Languages : en
  • Pages : 208

The book pulls together a series of articles by the authors that initiated the research areas of "optimal risk adjustment" and "optimal quality reporting." The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications.


Employment and Health Benefits

Employment and Health Benefits

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  • Author: Institute of Medicine
  • Publisher: National Academies Press
  • ISBN: 0309048273
  • Category : Medical
  • Languages : en
  • Pages : 381

The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages. Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices. Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments doâ€"and do not doâ€"to oversee employment-based health programs. A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored. Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care. With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee benefit managers and other executives, trade associations, and decisionmakers in the health insurance industry, as well as analysts, researchers, and students of health policy.


Regulated Competition in Health Insurance Markets

Regulated Competition in Health Insurance Markets

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  • Author: Rudy C. Douven
  • Publisher:
  • ISBN:
  • Category : Competition
  • Languages : en
  • Pages : 56


Reforming Private Health Insurance

Reforming Private Health Insurance

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  • Author: Mark A. Hall
  • Publisher: American Enterprise Institute
  • ISBN: 9780844738628
  • Category : Business & Economics
  • Languages : en
  • Pages : 128

Between 1987 and 1991, the portion of Americans covered by individually purchased health insurance dropped 40per cent. Assuming the US will continue to rely on private financing for health care, the author clarifies benefits to society from an efficient health insurance market.


Health Risk Pooling for Small-group Health Insurance

Health Risk Pooling for Small-group Health Insurance

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  • Author: White House Task Force on Health Risk Pooling (U.S.)
  • Publisher:
  • ISBN:
  • Category : Government publications
  • Languages : en
  • Pages : 108


Deriving Risk Adjustment Payment Weights to Maximize Efficiency of Health Insurance Markets

Deriving Risk Adjustment Payment Weights to Maximize Efficiency of Health Insurance Markets

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  • Author: Timothy J. Layton
  • Publisher:
  • ISBN:
  • Category : Adverse selection (Insurance)
  • Languages : en
  • Pages : 39

Abstract: Risk adjustment of payments to health plans is fundamental to regulated competition among private insurers, which serves as the basis of national health policy in many countries. To date, estimation and evaluation of a risk adjustment model has been a two-step process. In a first step, the risk-adjustment payment weights are estimated using statistical techniques, generally ordinary-least squares, to maximize some statistical objective such as the R-squared; then, in a second step, the risk adjustment model is evaluated, usually with simulation methods, but without an explicit framework describing the objective of the model. This paper first develops such a framework and then uses it to replace the two-step "estimate-then-evaluate" approach with a one-step "estimate-to-maximize-the-objective" approach. We assume that the objective of risk adjustment is to minimize the loss from service-level distortions due to adverse selection incentives, and we derive expressions for the service-level distortions as a linear function of the risk adjustment payment weights. We show that when the number of risk adjustor variables exceeds the number of decisions plans make about service allocations, incentives for service-level distortion can always be eliminated. Under these circumstances the welfare maximizing payment weights can be found with a constrained least-squares regression where the constraints are the conditions under which plan actions achieve efficiency. We illustrate this method with the data used to estimate risk adjustment payment weights in the Netherlands (N=16.5 million). When the number of "services" exceeds the number of available risk adjustors, however, it is not possible to eliminate incentives for service-level distortion. In this case, a regression on transformed data produces the (second-best) payment weights that minimize welfare loss


The Future of Disability in America

The Future of Disability in America

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  • Author: Institute of Medicine
  • Publisher: National Academies Press
  • ISBN: 0309104726
  • Category : Medical
  • Languages : en
  • Pages : 619

The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.


Reinsuring Health

Reinsuring Health

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  • Author: Katherine Swartz
  • Publisher: Russell Sage Foundation
  • ISBN: 1610445201
  • Category : Medical
  • Languages : en
  • Pages : 220

America's current system of health insurance, which relies almost exclusively on employer-sponsored coverage, is in danger of collapse, and this problem is not limited to the poor and working class. An increasing number of middle class Americans do not have employer-provided insurance and—due to skyrocketing premiums—cannot afford to purchase coverage for themselves. Reinsuring Health, by economist Katherine Swartz, examines this growing national crisis and outlines a concrete plan to make health insurance accessible and affordable for all Americans. Reinsuring Health documents why the number of uninsured Americans—now 45.5 million people—has grown in the last twenty-five years. Swartz focuses on how labor market changes—such as the decline of domestic manufacturing, decreased unionization, and the growth of non-standard work arrangements—have led U.S. employers to retreat from providing health insurance for their workers. These trends, combined with the increasing costs of medical care, have led to an explosion in health insurance premiums and a decline in coverage, particularly among the middle-class. Since those who seek insurance as individuals are generally most likely to need health care, private insurers charge higher premiums in the individual (non-group) markets than to people who obtain group insurance. This makes individual health insurance less attractive to the young and increasingly unaffordable for middle-class Americans. Similarly, insurers charge higher per person (or per family) premiums to small firms than to large companies, so many small firms do not sponsor coverage for their employees. Reinsuring Health shows how these problems can be overcome if the federal government provides a new reinsurance program which would protect insurance companies that provide small group and individual health insurance against the possibility that their policy-holders will incur very high medical expenses. By assuming some of the risk that people will face extremely costly medical bills, the government will make insurers less hesitant to offer coverage to high-risk individuals, and will help drive down premiums for others. Reinsuring Health demonstrates that this form of government reinsurance has worked in the past, helping to establish smooth running private markets for catastrophe insurance and secondary mortgages. Today, growing numbers of middle class Americans lack health insurance. Protection against the possibility of falling ill or getting hurt and having to pay extraordinary health care bills should not be a luxury available only to the very rich and the very poor. Reinsuring Health proposes a straightforward solution that would bring health insurance back within the reach of the increasing ranks of the uninsured, particularly those who are in the middle class.