Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice

Many countries rely on regulated competition in health insurance markets to provide health insurance to all or significant segments of their populations. The intention is to combine individual affordability of health plans with incentives for efficiency. Health plan payment systems play a crucial role in achieving this goal. The first part of Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets describes the goals, design and evaluation of health plan payment systems. Chapter 1 discusses the role of health plan payment in regulated health insurance markets. Chapter 2 describes key aspects of payment design (i.e. premium regulation, risk sharing and risk adjustment) and discusses how these aspects relate to public objectives such as efficiency, individual affordability, fairness and avoidance of risk selection. Chapter 3 takes a closer look on the most complex aspect, risk adjustment, and provides a conceptual toolkit for specifying a risk adjustment formula. Chapter 4 provides a practical toolkit for evaluating payment systems and illustrates various evaluation measures using administrative data on medical spending and risk characteristics of 16.5 million individuals supplemented with health survey information for nearly 400,000 of these individuals. The authors demonstrate how the right measure follows from the specific goals of a health plan payment system. The second part of the book describes the health plan payment systems applied in Belgium, Germany, Israel, the Netherlands, Switzerland, the United States in terms of the key aspects formulated in the first part of the book. Moreover, the authors discuss the evolution of these payment schemes as well as ongoing reforms and draw key lessons for the design of health plan payment. Provides a conceptual toolkit to describe the goals, design and evaluation of health plan payment systems in the context of paradigms such as efficiency, affordability, fairness and avoidance of risk selectionBrings together international experience from many different countries that apply managed competition in many different ways, reviewing key lessons for payment design for complex insurance productsDelivers a practical toolkit for the evaluation of payment modalities, their inefficiencies, side-effects and path of least resistance INDICE: 1. General introduction 2. Key aspects of health plan payment 3. Specification of risk adjustment 4. Evaluation of health plan payment systems

• ISBN: 978-0-12-811325-7
• Editorial: Academic Press
• Encuadernacion: Rústica
• Páginas: 600
• Fecha Publicación: 01/08/2018
• Nº Volúmenes: 1
• Idioma: Inglés