منابع مشابه
Risk 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 کاملRisk adjustment in aging societies
BACKGROUND In Switzerland, age is the predominant driver of solidarity transfers in risk adjustment (RA). Concerns have been voiced regarding growing imbalances in cost sharing between young and old insured due to demographic changes (larger fraction of elderly >65 years and rise in average age). Particularly young adults aged 19-25 with limited incomes have to shoulder increasing solidarity bu...
متن کاملIs the RACHS-1 (risk adjustment in congenital heart surgery) a useful tool in our scenario?
OBJECTIVE The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil. METHODS From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was ...
متن کاملCapping 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 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...
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ژورنال
عنوان ژورنال: World Journal of Gastroenterology
سال: 2005
ISSN: 1007-9327
DOI: 10.3748/wjg.v11.i16.2450