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首页> 外文期刊>Journal of health economics >Tradeoffs in the design of health plan payment systems: Fit, power and balance
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Tradeoffs in the design of health plan payment systems: Fit, power and balance

机译：健康计划支付系统设计中的权衡：适合性，力量和平衡

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摘要

In many markets, including the new U.S. Marketplaces, health insurance plans are paid by risk-adjusted capitation, sometimes combined with reinsurance and other payment mechanisms. This paper proposes a framework for evaluating the de facto insurer incentives embedded in these complex payment systems. We discuss fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement empirical metrics of fit, power, and balance in a study of Marketplace payment systems. Using data similar to that used to develop the Marketplace risk adjustment scheme, we quantify tradeoffs among the three classes of incentives. We show that an essential tradeoff arises between the goals of limiting costs and limiting cream skimming because risk adjustment, which is aimed at discouraging cream-skimming, weakens cost control incentives in practice. A simple reinsurance system scores better on our measures of fit, power and balance than the risk adjustment scheme in use in the Marketplaces. (C) 2016 Elsevier B.V. All rights reserved.
机译：在许多市场中，包括新的美国市场，健康保险计划都是通过风险调整后的人头来支付的，有时还与再保险和其他支付机制结合在一起。本文提出了一个框架，用于评估嵌入在这些复杂支付系统中的事实上的保险公司激励措施。我们讨论合适性，力量和平衡，每一个都针对健康保险的明显市场失灵。我们通过研究Marketplace付款系统来实现适合度，力量和平衡的经验指标。使用与用于开发市场风险调整计划的数据相似的数据，我们量化了三类激励措施之间的权衡。我们表明，在限制成本和限制脱脂奶油的目标之间出现了必不可少的折衷，因为旨在阻止脱脂奶油的风险调整实际上削弱了成本控制的动机。一个简单的再保险系统在我们的契合度，能力和平衡方面的得分要比市场中使用的风险调整方案更好。 （C）2016 Elsevier B.V.保留所有权利。

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