Risk adjustment, risk sharing and premium regulation in health insurance markets : theory and practice /: theory and practice. ([2018])

• Record Type: Book
• Further Information: Note: Edited by Thomas G. McGuire, Richard C. van Kleef.
• Editors: McGuire, Thomas G; Kleef, Richard van
• Contents: Front Cover; Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets; Copyright Page; Contents; List of Contributors; Regulated Competition in Health Insurance Markets: Foreword by Alain Enthoven; Acknowledgments; I: Theory; 1 Regulated Competition in Health Insurance Markets: Paradigms and Ongoing Issues; 1.1 Introduction; 1.2 Intellectual Roots of Regulated Competition; 1.2.1 Evolution of the Enthoven Model: Individual-Insurance Markets Managed by a Sponsor-Regulator; 1.2.2 Diamond Model: "First-Stage" Group-Level Competition; 1.3 Prevalence of Regulated Competition 1.3.1 Individual and Group-Level Competition in the United States1.3.2 Individual-Level Competition in Europe; 1.3.3 Regulated Competition in Australia, Asia, and Latin America; 1.4 The Role of Health Plan Payment in Regulated Competition; 1.4.1 The Broader Menu of Regulatory Tools; 1.4.2 Regulation of Health Plan Payment; 1.5 The Outline of This Volume; Endnote; 2 Premium Regulation, Risk Equalization, Risk Sharing, and Subsidies: Effects on Affordability and Efficiency; 2.1 Introduction; 2.1.1 Risk Rating: A Threat to the Affordability of Basic Coverage for High-Risk People 2.1.2 Risk Selection: A Threat to Both Affordability and Efficiency2.1.3 The Goal and Outline of This Chapter; 2.2 Starting Point of Our Analyses; 2.3 How Risk Rating and Risk Selection Affect Efficiency: A Graphical Framework; 2.3.1 Risk Rating: Good for Efficiency; 2.3.2 Risk Selection by Consumers: Bad for Efficient Sorting; 2.3.3 Risk Selection by Insurers: Bad for Efficiency of Plan Design and Efficiency of Production; 2.4 Benchmark for Analyzing the Effects of Payment System Interventions; 2.5 Premium Regulation; 2.6 Risk Equalization, Risk Sharing, and Subsidies to Insurers 2.6.1 Risk Equalization Without an External Subsidy2.6.2 Risk Sharing Without an External Subsidy; 2.6.3 Effects of Risk Equalization and Risk Sharing Without an External Subsidy; 2.6.4 The Effects of an External Subsidy to Insurers; 2.6.5 Risk Equalization or Risk Sharing With an External Fixed Subsidy; 2.7 Subsidies to Consumers; 2.7.1 Premium-Based Subsidies to Consumers; 2.7.2 Risk-Based Subsidies to Consumers; 2.7.3 Income-Based Subsidies to Consumers; 2.8 Summary and Conclusion; Acknowledgments; 3 Risk Adjustment for Health Plan Payment; 3.1 Introduction 3.2 Criteria Guiding the Design of Risk Adjustment Models3.2.1 Efficiency; 3.2.1.1 Avoiding Endogenous Signals; 3.2.1.2 Avoiding Noisy Signals; 3.2.1.3 Avoiding Incentives Not to Prevent or Cure; 3.2.1.4 Maintaining Incentives for Cost Control ("Power"); 3.2.1.5 Avoiding Overpayment; 3.2.1.6 Avoiding Service-Level Selection Incentives; 3.2.2 Fairness; 3.2.3 Feasibility; 3.2.4 Ten Principles in Pope et al. (2004); 3.3 Choice of Estimation Sample; 3.3.1 Sample Exclusions; 3.3.2 Separate Formulas for Population Subgroups; 3.3.3 Separate Formulas for Different Health Plan Benefits
• Publisher Details: London : Academic Press
• Publication Date: 2018
• Copyright Date: 2018
• Extent: 1 online resource
• Subjects: 368.382; Health insurance -- Cost control; Health insurance premiums; BUSINESS & ECONOMICS / Insurance / Risk Assessment & Management; Electronic books
• Languages: English
• ISBNs: 9780128113264
• Related ISBNs: 012811326X; 9780128113257
• Notes: Note: Includes bibliographical references and index.; Note: Online resource; title from PDF title page (EBSCO, viewed August 22, 2018).
• Access Rights: Legal Deposit; Only available on premises controlled by the deposit library and to one user at any one time; The Legal Deposit Libraries (Non-Print Works) Regulations (UK).
• Access Usage: Restricted: Printing from this resource is governed by The Legal Deposit Libraries (Non-Print Works) Regulations (UK) and UK copyright law currently in force.