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首页> 外文期刊>International Journal of Environmental Research and Public Health >Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas
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Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

机译：风险选择，风险调整和选择：美洲的概念和课程

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摘要

Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems.
机译：由于含有成本，改善公平性和减少医疗保健市场的选择问题，因此兴趣在全球范围内成长为风险调整和风险分摊。风险调整模型的实证开发，以及风险调整和风险分享的理论基础上取得了重大步骤。这种文献通常模仿风险调整的影响，而不会突出风险调整旨在解决风险调整的机构制定，法规和不同的选择问题。也许是因为这一点，现有的文献及其最佳风险调整或最佳支付系统的建议有时会混淆。在本文中，我们提出了一种统一的思考卫生保健系统组织结构的思考，使我们能够专注于接受较少关注的市场的两个关键维度：有什么可能导致选择问题的选择，以及什么风险调整以外的财务或监管工具用于影响这些选择。我们专门检查了四个国家的医疗保健系统，选择和问题：美国，加拿大，智利和哥伦比亚，并研究了与选择相关效率和公平问题的关系以及每个国家的选择，并讨论最近影响选择和选择问题的监管改革。在此示例中，具有更多选择的国家和保险计划具有更多选择问题。

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