Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T05:01:00.410Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk adjustment and risk equalization: what needs to be done?

Published online by Cambridge University Press:  26 January 2011

Wynand P. M. M. Van de Ven
Wynand P. M. M. Van de Ven*
Affiliation:
Professor of Health Insurance, Department of Health Insurance, Erasmus University Rotterdam, Rotterdam, The Netherlands
*
Correspondence to: Wynand P. M. M. Van de Ven, Professor of Health Insurance, Department of Health Insurance, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands. Email: vandeven@bmg.eur.nl
Get access Rights & Permissions [Opens in a new window]

Abstract

In this paper, we first deal with the rationale of risk adjustment and risk equalization in health insurance markets. Then we discuss the state of the art concerning the application of risk adjustment and risk equalization in practice. Finally, we focus on: What needs to be done?

Type
What to Do?
Information
Health Economics, Policy and Law , Volume 6 , Issue 1 , 26 January 2011 , pp. 147 - 156
Copyright
Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Armstrong, J. (2010), ‘Risk equalization and voluntary health insurance markets: the case of Ireland’, Health Policy, 98(1): 15–26.CrossRefGoogle ScholarPubMed
Armstrong, J., McLeod, H., Paolucci, F.Van de Ven, W. P. M. M. (2010), ‘Risk equalization in voluntary health insurance markets: a three country comparison’, Health Policy, 98(1): 39–49.CrossRefGoogle ScholarPubMed
Beaulieu, N., Cutler, D. M., Ho, K., Isham, G., Lindquist, T., Nelson, A.O’Connor, P. (2006), ‘The business case for diabetes disease management for managed care organizations’, Forum for Health Economics & Policy, 9(1): 1–36.CrossRefGoogle Scholar
Colombo, F., Tapay, N. (2003), ‘Private Health Insurance in Australia; case study’, OECD Health Working Papers, 30 October 2003.Google Scholar
Gale, A. P. (2005), ‘What price health? Private health insurance cost pressures and product pricing’, The Institute of Actuaries of Australia, Paper presented to the Institute of Actuaries of Australia 2005 Biennial Convention, 8–1 May 2005.Google Scholar
Lamers, L. M.van Vliet, R. C. J. A. (1996), ‘Multiyear diagnostic information from prior hospitalizations as a risk-adjuster for capitation payments’, Medical Care, 34(6): 549–561.CrossRefGoogle ScholarPubMed
McLeod, H.Grobler, P. (2010), ‘Risk equalization and voluntary health insurance markets: the South Africa experience’, Health Policy, 98(1): 27–38.CrossRefGoogle ScholarPubMed
Newhouse, J. P., Buntin, M. B.Chapman, J. D. (1997), ‘Risk adjustment and Medicare: taking a closer look’, Health Affairs, 16(5): 26–43.CrossRefGoogle ScholarPubMed
Newhouse, J. P. (1996), ‘Reimbursing health plans and health providers: efficiency in production versus selection’, Journal of Economic Literature, 34(3): 1236–1263.Google Scholar
Paolucci, F., den Exter, A.Van de Ven, W. P. M. M. (2006), ‘Solidarity in competitive health insurance markets: analysing the relevant EC legal framework’, Health Economics, Policy and Law, 1: 101–126.CrossRefGoogle ScholarPubMed
Pope, G. C., Kautter, J., Ellis, R. P., Ash, A. S., Ayanian, J. Z., Iezzoni, L. I., Ingber, M. J., Levy, J. M., Robst, J. (2004), ‘Risk adjustment of medicare capitation payments using the CMS-HCC model’, Health Care Financing Review, 25: 119–141.Google ScholarPubMed
Rothschild, M.Stiglitz, J. (1976), ‘Equilibrium in competitive insurance markets: an essay on the economics of imperfect information’, Quarterly Journal of Economics, 90: 629–649.CrossRefGoogle Scholar
Stam, P. J. A., Van de Ven, W. P. M. M. (2007), Evaluatie risicoverevening: prikkels tot risicoselectie?, Report, 17 september 2007, Erasmus University Rotterdam. See also: ‘De harde kern in de risicoverevening’. Economisch Statische Berichten (ESB), 22 February 2008.Google Scholar
Van Barneveld, E. M., Lamers, L. M., Van Vliet, R. C. J. A.Van de Ven, W. P. M. M. (2000), ‘Ignoring small predictable profits and losses: a new approach for measuring incentives for cream skimming’, Health Care Management Science, 3: 131–140.CrossRefGoogle ScholarPubMed
Van Barneveld, E. M., Lamers, L. M., Van Vliet, R. C. J. A.Van de Ven, W. P. M. M. (2001), ‘Risk sharing as a supplement to imperfect capitation: a tradeoff between selection and efficiency’, Journal of Health Economics, 20(2): 147–168.CrossRefGoogle ScholarPubMed
Van de Ven, W. P. M. M., Van Vliet, R. C. J. A., Schut, F. T.Van Barneveld, E. M. (2000), ‘Access to coverage for high-risk consumers in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted premium subsidies?’, Journal of Health Economics, 19: 311–339.CrossRefGoogle ScholarPubMed
Van de Ven, W. P. M. M., van Vliet, R. C. J. A., Lamers, L. M. (2004), ‘Health-adjusted premium subsidies in the Netherlands’, Health Affairs, 23(3): 45–55.CrossRefGoogle ScholarPubMed
Van de Ven, W. P. M. M., Beck, K., Van de Voorde, C., Wasem, J.Zmora, I. (2007), ‘Risk adjustment and risk selection in Europe: six years later’, Health Policy, 83: 162–179.CrossRefGoogle Scholar
Van de Ven, W. P. M. M., Schut, F. T., Hermans, H. E. G. M., de Jong, J. D., Van der Maat, M., Coppen, R., Groenewegen, P. P.Friele, R. D. (2009), Evaluatie: Zorgverzekeringswet en Wet op de zorgtoeslag, DenHaag: ZonMw.Google Scholar
Van Kleef, R., Beck, K., Van de Ven, W. P. M. M.Van Vliet, R. C. J. A. (2008), ‘Risk equalization and voluntary deductibles a complex interaction’, Journal of Health Economics, 27: 427–443.CrossRefGoogle ScholarPubMed
Van Kleef, R., Van Vliet, R. C. J. A. (2009), ‘Ontwikkeling Hulpmiddelen Kosten Groep’, Research for the Department of Health, Netherlands, WOR419, Februari 2009.Google Scholar
Van Vliet, R. C. J. A. (2007), Vervolgonderzoek naar compensatie voor zeldzame aandoeningen in het Zvw-risicovereveningsmodel; bundel deelrapportages, Rotterdam: iBMG, Erasmus Universiteit Rotterdam, Onderzoek voor het Ministerie van VWS.Google Scholar