Improving the prediction model used in risk equalization: cost and diagnostic information from multiple prior years
| Autor: | R. C. van Kleef, S. van Veen, R.C.J.A. van Vliet, W. P. M. M. van de Ven |
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| Přispěvatelé: | Health Systems and Insurance (HSI) |
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Adolescent Computer science media_common.quotation_subject Economics Econometrics and Finance (miscellaneous) Population Insurance Carriers Young Adult Sex Factors Risk Factors Value judgment Health care Risk equalization Humans Cost Sharing Medical diagnosis Child education Aged Netherlands media_common education.field_of_study Insurance Health Models Statistical Health economics Actuarial science business.industry Health Policy Age Factors Infant Newborn Infant Middle Aged Payment Policy Incentive Socioeconomic Factors Child Preschool Female Risk Adjustment Health Expenditures business |
| Zdroj: | The European Journal Of Health Economics, 16(2), 201-218. Springer-Verlag |
| ISSN: | 1439-6637 1439-3972 1618-7598 |
| DOI: | 10.1007/s10198-014-0567-7 |
| Popis: | Currently-used risk-equalization models do not adequately compensate insurers for predictable differences in individuals' health care expenses. Consequently, insurers face incentives for risk rating and risk selection, both of which jeopardize affordability of coverage, accessibility to health care, and quality of care. This study explores to what extent the predictive performance of the prediction model used in risk equalization can be improved by using additional administrative information on costs and diagnoses from three prior years. We analyze data from 13.8 million individuals in the Netherlands in the period 2006-2009. First, we show that there is potential for improving models' predictive performance at both the population and subgroup level by extending them with risk adjusters based on cost and/or diagnostic information from multiple prior years. Second, we show that even these extended models do not adequately compensate insurers. By using these extended models incentives for risk rating and risk selection can be reduced substantially but not removed completely. The extent to which risk-equalization models can be improved in practice may differ across countries, depending on the availability of data, the method chosen to calculate risk-adjusted payments, the value judgment by the regulator about risk factors for which the model should and should not compensate insurers, and the trade-off between risk selection and efficiency. |
| Databáze: | OpenAIRE |
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