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...

OBJECTIVE In 2014, an estimated 15 million individuals who currently do not have health insurance, including many with chronic mental illness, are expected to obtain coverage through state insurance exchanges. The authors examined how two mechanisms in the Affordable Care Act (ACA), namely, risk adjustment and reinsurance, might perform to ensure the financial solvency of health plans that have...

objective: infertility is considered as an intense and prolonged stressful experience. despite of high prevalence of infertility and its emotional burden for couples and especially for women, materials and methods: the knowledge regarding psychological factors influencing adjustment to it is limited. the aim of the present study was to investigate the mediational role of cognitive emotion regul...

Background: Psoriasis is a prevalent chronic T cell mediated inflammatory skin disorder. Recent studies have reported an increase in the incidence of arrhythmia in psoriasis patients who run an excessive risk of metabolic syndrome and cardiovascular diseases. P-wave dispersion (PWD) and duration are important electrocardiographic (ECG) markers employed to anticipate the risk of atrial arrhythmi...

OBJECTIVE To develop a risk adjustment method for HbA1c, based solely on administrative data and to determine the extent to which risk-adjusted HbA1c changes the identification of high- or low-performing medical facilities. RESEARCH DESIGN AND METHODS Through use of pharmacy records, 204,472 diabetic patients were identified for federal fiscal year 1996 (FY96). Complete information (HbA1c lev...

BACKGROUND There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home...

A distinction between parental behavioral control and psychological control has been elucidated in the literature, yet far less is known about the role of psychological control in youth adjustment broadly or risky behavior in particular. We examined the interrelationship of maternal psychological control, youth psychosocial adjustment, and youth risk behaviors among African American single moth...

Neuroticism, a broad personality trait linked to negative emotions, is consistently linked to ill health when self-report is used to assess health. However, when health risk is assessed with biomarkers, the evidence is inconsistent. Here, we tested the hypothesis that the association between neuroticism and biological health risk is moderated by behavioral adjustment, a propensity to flexibly a...

OBJECTIVES To develop a propensity score-based risk adjustment method to estimate the performance of 20 physician groups and to compare performance rankings using our method to a standard hierarchical regression-based risk adjustment method. DATA SOURCES/STUDY SETTING Mailed survey of patients from 20 California physician groups between July 1998 and February 1999. STUDY DESIGN A cross-sect...

INTRODUCTION In critical care observational studies, when clinicians administer different treatments to sicker patients, any treatment comparisons will be confounded by differences in severity of illness between patients. We sought to investigate the extent that observational studies assessing treatments are at risk of incorrectly concluding such treatments are ineffective or even harmful due t...