
Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets
Theory and Practice
Description
Key Features
- Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection
- Brings together international experience from many different countries that apply regulated competition in different ways
- Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness
Readership
Senior under(graduate) students interested in health policy. Policymakers responsible for health plan payment. Health insurers, policy researchers, patient organizations and other organizations involved in the design of risk equalisation schemes, those working as actuaries for insurance companies, and anyone involved in the political process of health plan payment design
Table of Contents
1. Regulated Competition in Health Insurance Markets: Paradigms and Ongoing Issues
2. Premium Regulation, Risk Equalization, Risk Sharing, and Subsidies: Effects on Affordability and Efficiency
3. Risk Adjustment for Health Plan Payment
4. Risk Sharing
5. Evaluating the Performance of Health Plan Payment Systems
6. Health Plan Payment in Australia
7. Risk Adjustment in Belgium: Why and How to Introduce Socioeconomic Variables in Health Plan Payment
8. Health Plan Payment in Chile
9. Health Insurance and Payment System Reform in China
10. Health Plan Payment in Colombia
11. Health Plan Payment in Germany
12. Health Plan Payment in Ireland
13. Regulated Competition and Health Plan Payment Under the National Health Insurance Law in Israel—The Unfinished Story
14. Health Plan Payment in the Netherlands
15. Health Plan Payment in the Russian Federation
16. Health Plan Payment in Switzerland
17. Health Plan Payment in US Marketplaces: Regulated Competition With a Weak Mandate
18. Health Plan Payment in Medicaid Managed Care: A Hybrid Model of Regulated Competition
19. Medicare Advantage: Regulated Competition in the Shadow of a Public Option
Product details
- No. of pages: 648
- Language: English
- Copyright: © Academic Press 2018
- Published: August 6, 2018
- Imprint: Academic Press
- Paperback ISBN: 9780128113257
- eBook ISBN: 9780128113264
About the Editors
Thomas McGuire
Affiliations and Expertise
Richard Van Kleef
Affiliations and Expertise
Ratings and Reviews
Latest reviews
(Total rating for all reviews)
MariaTrottmann Sat Dec 15 2018
Full of insights and still accessible
This book offers a brilliant overview over risk adjustment in managed-competition type health care systems. The five chapters in part one explain the theory in an intuitive and accessible way. The 14 country specific chapters in part II provide countless practical insights into the implementation of the model, and some of the problems involved with it. I especially enjoyed the fact that societal goals and the economic rationale for risk adjustment are discussed in detail. Every regulator / adviser should own a copy!