ArticleHealth economics2022
How to deal with persistently low/high spenders in health plan payment systems?
Article in Health economics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Exploration of using constrained regression in Germany's morbidity-based risk adjustment.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- A critical review of the use of RThe European journal of health economics : HEPAC : health economics in prevention and care · 2025Review
- Risk adjustment for regional healthcare funding allocations with ensemble methods: an empirical study and interpretation.The European journal of health economics : HEPAC : health economics in prevention and care · 2024Article
- A framework for ex-ante evaluation of the potential effects of risk equalization and risk sharing in health insurance markets with regulated competition.Health economics review · 2024Review
- Heteroscedasticity of residual spending after risk equalization: a potential source of selection incentives in health insurance markets with premium regulation.The European journal of health economics : HEPAC : health economics in prevention and care · 2024Article
- High-risk pooling for mitigating risk selection incentives in health insurance markets with sophisticated risk equalization: an application based on health survey information.BMC health services research · 2024Article
- How to deal with persistently low/high spenders in health plan payment systems?Health economics · 2022Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Health insurance markets with community-rated premiums typically include risk adjustment (RA) to mitigate selection problems. Over the past decades, RA systems have evolved from simple demographic models to sophisticated morbidity-based models. Even the most sophisticated models, however, tend to overcompensate people with persistently low spending and undercompensate those with persistently high spending. This paper compares three methods that exploit spending-level persistence for improving health plan payment systems: (1) implementation of spending-based risk adjustors, (2) implementation of high-risk pooling for people with multiple-year high spending, and (3) indirect use of spending persistence via constrained regression. Based on incentive measures for risk selection and cost control, we conclude that a combination of the last two options can substantially outperform the first, which is currently used in the health plan payment system in the Netherlands.
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