منابع مشابه
Capping risk adjustment?
When premiums are community-rated, risk adjustment (RA) serves to mitigate competitive insurers' incentive to select favorable risks. However, unless fully prospective, it also undermines their incentives for efficiency. By capping its volume, one may try to counteract this tendency, exposing insurers to some financial risk. This in term runs counter the quest to refine the RA formula, which wo...
متن کاملRisk Selection and Risk Adjustment
Synopsis: Risk selection, which occurs when an individual’s demand for a product is correlated with her risk, creates inefficiencies and inequalities in markets for those products and services. Studies have shown that risk selection often occurs in health care markets, especially in markets for health insurance. Risk adjustment is a method that has been developed to correct those inefficiencies...
متن کاملCost-minimizing risk adjustment.
Conventional risk adjustment, which sets capitation payments equal to the average cost of individuals with similar observable characteristics, is not optimal if health plans can use private information to select low-cost enrollees. "Cost-minimizing risk adjustment" minimizes the sum of capitated HMO premiums plus FFS costs by balancing the gains from HMO cost efficiency against the overpayments...
متن کاملRisk Adjustment and Prevention
Widespread integration of market-based incentives into healthcare systems calls for — and has elicited — increasing adoption of risk adjustment. By deterring selection, risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds among regions or insurers according to current populatio...
متن کاملRisk adjustment and risk-adjusted provider profiles
Provider profiles are an important component of efforts to improve both healthcare productivity and quality. Risk adjustment is the attempt to account for differences in the risk for specific outcomes of cases in different groups in order to facilitate more meaningful comparisons. The value of provider profiles, whether used internally or released to the public, depends both on adequate risk ad...
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ژورنال
عنوان ژورنال: Journal of Health Economics
سال: 2010
ISSN: 0167-6296
DOI: 10.1016/j.jhealeco.2010.04.001