Risk Selection Threatens Quality Of Care For Certain Patients: Lessons From Europe's Health Insurance Exchanges.
Experience in European health insurance exchanges indicates that even with the best risk-adjustment formulas, insurers have substantial incentives to engage in risk selection. The potentially most worrisome form of risk selection is skimping on the quality of care for underpriced high-cost patients-...
| Publicado en: | Health Affairs Vol. 34; no. 10; pp. 1713 - 1721 |
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| Autores principales: | , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Health Affairs Publishing, LLC
Oct2015
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110231499&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 110231499 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02782715 HAF jtl: Health Affairs issn: 02782715 maglogo: N pubinfo: dt: Oct2015 vid: 34 iid: 10 pid: 1453 pub: Health Affairs Publishing, LLC place: Washington, District of Columbia artinfo: ui: 110231499 110231499 110231499 10.1377/hlthaff.2014.1456 NLM26438748 110231499 ppf: 1713 ppct: 8 formats: tig: atl: Risk Selection Threatens Quality Of Care For Certain Patients: Lessons From Europe's Health Insurance Exchanges. aug: au: van de Ven, Wynand P. M. M. van Kleef, Richard C. van Vliet, Rene C. J. A. affil: Professor, Institute of Health Policy and Management, Erasmus University, Rotterdam, Netherlands sug: subj: Health Insurance Exchanges Europe Insurance Coverage Risk Assessment Quality of Health Care Insurance, Health, Reimbursement Europe United States Quality Improvement Patient Protection and Affordable Care Act Insurance Carriers Human Comparative Studies Data Analysis, Statistical Variable Policy Making Funding Source ab: Experience in European health insurance exchanges indicates that even with the best risk-adjustment formulas, insurers have substantial incentives to engage in risk selection. The potentially most worrisome form of risk selection is skimping on the quality of care for underpriced high-cost patients--that is, patients for whom insurers are compensated at a rate lower than the predicted health care expenses of these patients. In this article we draw lessons for the United States from twenty years of experience with health insurance exchanges in Europe, where risk selection is a serious problem. Mistakes by European legislators and inadequate evaluation criteria for risk selection incentives are discussed, as well as strategies to reduce risk selection and the complex trade-off among selection (through quality skimping), efficiency, and affordability. Recommended improvements to the risk-adjustment process in the United States include considering the adoption of risk adjusters used in Europe, investing in the collection of data, using a permanent form of risk sharing, and replacing the current premium "band" restrictions with more flexible restrictions. Policy makers need to understand the complexities of regulating competitive health insurance markets and to prevent risk selection that threatens the provision of good-quality care for underpriced high-cost patients. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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