کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
961286 | 929835 | 2013 | 15 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Integrating risk adjustment and enrollee premiums in health plan payment
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کلمات کلیدی
موضوعات مرتبط
علوم پزشکی و سلامت
پزشکی و دندانپزشکی
سیاست های بهداشت و سلامت عمومی
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چکیده انگلیسی
In two important health policy contexts - private plans in Medicare and the new state-run “Exchanges” created as part of the Affordable Care Act (ACA) - plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS).
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Health Economics - Volume 32, Issue 6, December 2013, Pages 1263-1277
Journal: Journal of Health Economics - Volume 32, Issue 6, December 2013, Pages 1263-1277
نویسندگان
Thomas G. McGuire, Jacob Glazer, Joseph P. Newhouse, Sharon-Lise Normand, Julie Shi, Anna D. Sinaiko, Samuel H. Zuvekas,