Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Chapters discuss the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. premium regulation, risk sharing and risk adjustment), how to evaluate payment systems, various evaluation measures using administrative data on medical spending and the risk characteristics of 16.5 million individuals. The book's authors demonstrate how the right measure follows from the specific goals of a health plan payment system.
Additional sections describe the health plan payment systems applied in Belgium, Germany, Israel, the Netherlands, Switzerland and the United States. Moreover, the authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment.
- Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of paradigms, such as efficiency, affordability, fairness and avoidance of risk selection
- Brings together international experience from many different countries that apply managed competition in different ways
- Delivers a practical toolkit for the evaluation of payment modalities, their inefficiencies, side-effects and paths of least resistance
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
1. General introduction
2. Key aspects of health plan payment
3. Specification of risk adjustment
4. Evaluation of health plan payment systems
- No. of pages:
- © Academic Press 2018
- 1st August 2018
- Academic Press
- Paperback ISBN:
Thomas McGuire is a Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School and a Research Associate at the National Bureau of Economic Research. His research focuses on the design and impact of health care payment systems, the economics of health care disparities, and the economics of mental health policy and drug regulation and payment. McGuire has contributed to the theory of physician, hospital, and health plan payment. McGuire was a co-editor of the Handbook of Health Economics Volume 2 (2012) and recently completed ten years as an editor of the Journal of Health Economics.
Professor of Health Economics, Department of Health Care Policy, Harvard Medical School and Research Associate, National Bureau of Economic Research
Richard van Kleef works as an Associate Professor at the Institute of Health Policy and Management of the Erasmus University, Rotterdam. His research and teaching focus on economic aspects of health insurance and health care markets. Specific areas of expertise are health plan payment and consumer cost sharing. Richard has published his research in national and international journals including the Journal of Health Economics, The European Journal of Health Economics, Medical Care, Health Affairs and Health Policy. Richard is also a policy advisor, the chairman of the Dutch/Flemish Health Economics Association and a member of the risk adjustment network (RAN).
Associate Professor, Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands