Risk Selection and Risk Adjustment
نویسندگان
چکیده
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 by using models to calculate risk and compensate suppliers for the risk of each individual purchasing their products. These models have become more sophisticated in recent years and are currently used in the health care systems of a number of countries.
منابع مشابه
Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas
Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adju...
متن کاملPrevention and Dynamic Risk Adjustment
Risk adjustment deters selection and helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds among insurers or regions according to current population health status, it does not reward — indeed, it penalizes — provider preventive efforts that improve population health. This prevention penalty of ...
متن کاملRisk Adjustment, Innovation 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 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 کاملA New Approach to Project Risk Responses Selection with Inter-dependent Risks
Risks are natural and inherent characteristics of major projects. Risks are usually considered independently in analysis of risk responses. However, most risks are dependent on each other and dependent risks are rare in the real world. This paper proposes a model for proper risk response selection from the responses portfolio with the purpose of optimization of defined criteria for projects. Th...
متن کاملHow profitable is risk selection? A comparison of four risk adjustment models.
To mitigate selection triggered by capitation payments, risk-adjustment models bring capitation payments closer on average to individuals' expected expenditure. We examine the maximum potential profit that plans could hypothetically gain by using their own private information to select low-cost enrollees when payments are made using four commonly used risk adjustment models. Simulations using a...
متن کامل