Risk adjustment and risk selection in Europe: 6 years later

Ven, Wynand P.M.M. van de; Beck, Konstantin; Voorde, Carine Van de; Wasem, Jürgen; Zmora, Irit

doi:10.1016/j.healthpol.2006.12.004

Cited by 102 publications

(85 citation statements)

References 17 publications

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“…Managed competition in social health insurance aims at creating incentives for insurers to increase efficiency and respond to consumer preferences while preserving solidarity between high-and low-risk types (Van de Ven et al [2007]). Therefore, it is important to know whether contractual innovations such as deductibles or capitated IPA plans achieve true cost savings rather than merely serving as a means for risk selection.…”

Section: Discussionmentioning

confidence: 99%

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Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?

Trottmann

Zweifel

Beck

2012

Journal of Health Economics

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Microeconomic theory predicts that if patients are fully insured and providers are paid fee-forservice, utilization of medical services exceeds the efficient level ('moral hazard effect'). In Switzerland, both demand-side cost sharing and upply-side cost sharing have been introduced to mitigate this problem. Analyzing a panel dataset of about 150,000 adults, we find both types of cost sharing to be effective in curtailing the use of medical services. However, demand-side cost sharing options are preliminarily chosen by individuals in excellent health, causing 'true' cost savings achieved by supply-side cost sharing to be more important. adults, we find both types of cost sharing to be effective in curtailing the use of medical services. However, demand-side cost sharing options are preliminarily chosen by individuals in excellent health, causing 'true' cost savings achieved by supply-side cost sharing to be more important.

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Section: Discussionmentioning

confidence: 99%

“…Swiss health insurance is of the 'managed competition' type (Enthoven [1978], Van de Ven et al [2007]). Coverage is mandatory for a rather comprehensive 'basic' basket of medical services and pharmaceuticals, written by some 80 private, not-for-profit insurers competing in a regulated market.…”

Section: Swiss Health Insurancementioning

confidence: 99%

Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?

Trottmann

Zweifel

Beck

2012

Journal of Health Economics

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“…Risk sharing lessens the degree of financial risk insurers bear and therefore lowers incentives for risk selection, but it also dampens incentives to operate efficiently (36). All four countries have strengthened their risk equalisation schemes in the last ten years and Belgium, Germany and the Netherlands now have relatively sophisticated formulas that include health-based risk adjusters (37)(38)(39).…”

Section: Risk Equalisationmentioning

confidence: 99%

“…The weakness of Switzerland's formula was widely acknowledged nationally, but action to strengthen it was blocked for many years by industry lobbying rather than by lack of data. In spite of the energy devoted to strengthening formulas, no country has fully eliminated incentives to select risks (38). Circumstantial evidence for all of the countries indicates there is risk selection through targeted advertising, through the use of reminders and discounts and through product differentiation in VHI 10 (8,20,38,51), while anecdotal evidence suggests insurers in some countries have tried to deter high risks from enrolling 11 .…”

Section: Policy Implicationsmentioning

confidence: 99%

Statutory health insurance competition in Europe: A four-country comparison

Thomson¹,

Busse

Crivelli

et al. 2013

Health Policy

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This article considers the potential for insurer competition to improve health system performance by strengthening purchasing. Economic theory suggests that insurer competition will enhance efficiency if: (1) people have free choice of insurer, (2) competition is based on price and quality rather than risk selection and (3) insurers have tools to influence health care costs and quality. The article assesses the extent to which these assumptions hold in Belgium, Germany, the Netherlands and Switzerland. It finds that health insurance market reforms in these countries have had mixed results in fulfilling these assumptions. In spite of significant investment in risk equalisation, incentives for risk selection remain. Consumer mobility is lower among older and chronically ill people, possibly due to close interaction between statutory and voluntary coverage. Although insurers in some countries increasingly have tools to enhance value, they may not always use them. The analysis suggests that the instrumental value of insurer competition rests on multiple assumptions that can only be upheld through frequently complex interventions often requiring elusive data. Making it work therefore requires action on several fronts, particularly to ensure incentives are aligned across the health system, and awareness of the political nature of some barriers to success.

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“…The Netherlands use a system based on inpatient diagnoses and pharmaceutical prescriptions only. In all countries, ways to capture and represent morbidity continue to evolve (Van de Ven et al, 2007;van Kleef et al, 2014).…”

Section: Risk-adjustment In the German Shimentioning

confidence: 99%

Plan responses to diagnosis-based payment: Evidence from Germany’s morbidity-based risk adjustment

Bauhoff

Fischer²,

Göpffarth

et al. 2017

Journal of Health Economics

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Many competitive health insurance markets adjust payments to participating health plans according to their enrollees' risk -including based on diagnostic information. We investigate responses of German health plans to the introduction of morbidity-based risk adjustment in the Statutory Health Insurance in 2009, which triggers payments based on "validated" diagnoses by providers. Using the regulator's data from office-based physicians, we estimate a difference-indifference analysis of the change in the share and number of validated diagnoses for ICD codes that are inside or outside the risk adjustment but are otherwise similar. We find a differential increase in the share of validated diagnoses of 2.6 and 3.6 percentage points (3-4%) between 2008 and 2013. This increase appears to originate from both a shift from not-validated toward validated diagnoses and an increase in the number of such diagnoses. Overall, our results indicate that plans were successful in influencing physicians' coding practices in a way that could lead to higher payments. Terms of use: Documents inJEL-Codes: H510, I100, I130, I180.

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Risk adjustment and risk selection in Europe: 6 years later

Cited by 102 publications

References 17 publications

Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?

Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?

Statutory health insurance competition in Europe: A four-country comparison

Plan responses to diagnosis-based payment: Evidence from Germany’s morbidity-based risk adjustment

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