Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market
| Autor: | Leida M. Lamers, René C.J.A. van Vliet, Wynand P.M.M. van de Ven, Erik M. van Barneveld |
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| Přispěvatelé: | Erasmus School of Health Policy & Management |
| Rok vydání: | 1998 |
| Předmět: |
Health (social science)
Cost Control National Health Programs Total cost media_common.quotation_subject Pooling Health Care Sector Efficiency Organizational Insurance Selection Bias History and Philosophy of Science Health care Health insurance Economics Humans health care economics and organizations Netherlands media_common Economic Competition Actuarial science Capitation business.industry Insurance Pools food and beverages Payment Risk Sharing Financial Cream skimming Incentive Health Care Reform Regression Analysis Health Services Research Capitation Fee business Forecasting |
| Zdroj: | Social Science & Medicine, 47(2), 223-232. Elsevier Ltd. |
| ISSN: | 0277-9536 |
| DOI: | 10.1016/s0277-9536(98)00056-2 |
| Popis: | Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in many countries. RACPs based on demographic variables only are insufficient, because they leave ample room for cream skimming. However, the implementation of improved RACPs does not appear to be straightforward. A solution might be to supplement imperfect RACPs with a form of mandatory pooling that reduces the incentives for cream skimming. In a previous paper it was concluded that high-risk pooling (HRP), is a promising supplement to RACPs. The purpose of this paper is to compare HRP with two other main variants of mandatory pooling. These variants are called excess-of-loss (EOL) and proportional pooling (PP). Each variant includes ex post compensations to insurers for some members which depend to various degrees on actually incurred costs. Therefore, these pooling variants reduce the incentives for cream skimming which are inherent in imperfect RACPs, but they also reduce the incentives for efficiency and cost containment. As a rough measure of the latter incentives we use the percentage of total costs for which an insurer is at risk. This paper analyzes which of the three main pooling variants yields the greatest reduction of incentives for cream skimming given such a percentage. The results show that HRP is the most effective of the three pooling variants. |
| Databáze: | OpenAIRE |
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