Risk equalisation in voluntary health insurance markets: A three country comparison

Armstrong, John; Paolucci, Francesco; McLeod, Heather; Ven, Wynand P.M.M. van de

doi:10.1016/j.healthpol.2010.06.009

Cited by 20 publications

(14 citation statements)

References 13 publications

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“…The data from Europe indicate that PHI generally leads to inequitable access to health care, does not contain costs or increase efficiency, and undermines the financial stability of statutory health insurance (Mossialos and Thomson, 2002;Thomson and Mossialos, 2004). Other countries that rely on PHI to varying extents, such as Australia and Chile, have encountered similar issues (Hall et al, 1999;Sapelli, 2004;Armstrong et al, 2010). However, the impact of PHI varies depending on the type of PHI, the regulatory environment and the relationship between the private and statutory systems (Colombo and Tapay, 2004).…”

Section: Phi: Empirical Evidence From High-income Countriesmentioning

confidence: 99%

Private Financing of Health Care in Times of Economic Crisis: a Review of the Evidence

Wouters

2016

Global Policy

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Many high-income countries have cut public health care spending since the global economic downturn in 2008. In some cases these cuts have been accompanied by calls to expand private financing to improve the efficiency of health systems. In low and middle-income countries seeking to increase access to health care, it is sometimes suggested that private financing is more effective than public financing because of weak state institutions and bureaucratic shortcomings. In this paper, we review the theoretical and empirical evidence on private financing in terms of cost, efficiency, equity and financial protection. We consider private health insurance, medical savings accounts and user charges in high, middle and low-income countries. The theoretical and empirical evidence reveals major market failures in the health sector. It is unlikely that private financing generates better results than public financing. Still, as private financing options are heterogeneous, it is possible that a particular form might play a beneficial role in a specific setting. Given the current state of knowledge, however, any calls to increase private financing must be accompanied by robust evidence, such as real world pilot studies.

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Section: Phi: Empirical Evidence From High-income Countriesmentioning

confidence: 99%

Private Financing of Health Care in Times of Economic Crisis: a Review of the Evidence

Wouters

2016

Global Policy

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“…In the course of this project, it became evident the confusion about the (use of the) term 'risk equalisation', and the importance of providing fresh and clear definitions in line with the existing literature [1][2][3] (see also the Glossary in [4]). First, a distinction needs to be made between risk equalisation (as in Ireland and South Africa) and claims equalisation (as currently in Australia).…”

Section: Context and Terminologymentioning

confidence: 99%

“…The literature has extensively considered the benefits of risk equalisation in health insurance markets [3,4].…”

Section: Context and Terminologymentioning

confidence: 99%

Risk equalisation in voluntary health insurance markets

2010

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“…Many state Medicaid programs engage in risk adjustment (Winkelman & Damler, 2008). Several countries have introduced risk adjustment as part of their regulated private health insurance markets, including the Netherlands, Switzerland, Germany, Ireland, Australia, and South Africa (Armstrong, Paolucci, McLeod, & van de Ven, 2010;Schokkaert et al, 2006). Historically, risk adjustment has not been commonly used in United States private health insurance markets.…”

Section: Introductionmentioning

confidence: 99%

Affordable Care Act Risk Adjustment: Overview, Context, and Challenges

Kautter¹,

Pope²,

Keenan³

2014

MMRR

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Abstract:Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge and the incentive for plans to avoid sicker enrollees.This article -the first of three in the Medicare & Medicaid Research Review-describes the key program goal and issues in the Department of Health and Human Services (HHS) developed risk adjustment methodology, and identifies key choices in how the methodology responds to these issues. The goal of the HHS risk adjustment methodology is to compensate health insurance plans for differences in enrollee health mix so that plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. The methodology includes a risk adjustment model and a risk transfer formula that together address this program goal as well as three issues specific to ACA risk adjustment: 1) new population; 2) cost and rating factors; and 3) balanced transfers within state/market. The risk adjustment model, described in the second article, estimates differences in health risks taking into account the new population and scope of coverage (actuarial value level). The transfer formula, described in the third article, calculates balanced transfers that are intended to account for health risk differences while preserving permissible premium differences.

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Risk equalisation in voluntary health insurance markets: A three country comparison

Cited by 20 publications

References 13 publications

Private Financing of Health Care in Times of Economic Crisis: a Review of the Evidence

Private Financing of Health Care in Times of Economic Crisis: a Review of the Evidence

Risk equalisation in voluntary health insurance markets

Affordable Care Act Risk Adjustment: Overview, Context, and Challenges

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