Health Plan Payment in Ireland

Armstrong, John

doi:10.1016/b978-0-12-811325-7.00012-9

Cited by 3 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consequently, consumers have many choice options and insurers have substantial flexibility regarding plan design. Insurers are obliged to participate in a simple risk equalization scheme with some (implicit) elements of risk sharing (Armstrong, 2018).…”

Section: Organizational Form Of Insurance Companies Amentioning

confidence: 99%

Scope and Incentives for Risk Selection in Health Insurance Markets With Regulated Competition: A Conceptual Framework and International Comparison

van Kleef,

Reuser,

McGuire

et al. 2024

Med Care Res Rev

Self Cite

View full text Add to dashboard Cite

In health insurance markets with regulated competition, regulators face the challenge of preventing risk selection. This paper provides a framework for analyzing the scope (i.e., potential actions by insurers and consumers) and incentives for risk selection in such markets. Our approach consists of three steps. First, we describe four types of risk selection: (a) selection by consumers in and out of the market, (b) selection by consumers between high- and low-value plans, (c) selection by insurers via plan design, and (d) selection by insurers via other channels such as marketing, customer service, and supplementary insurance. In a second step, we develop a conceptual framework of how regulation and features of health insurance markets affect the scope and incentives for risk selection along these four dimensions. In a third step, we use this framework to compare nine health insurance markets with regulated competition in Australia, Europe, Israel, and the United States.

show abstract

Section: Organizational Form Of Insurance Companies Amentioning

confidence: 99%

Scope and Incentives for Risk Selection in Health Insurance Markets With Regulated Competition: A Conceptual Framework and International Comparison

van Kleef,

Reuser,

McGuire

et al. 2024

Med Care Res Rev

Self Cite

View full text Add to dashboard Cite

show abstract

“…In Italy, approximately 35% (outpatient service and half of hospital expenditure) of the Italian National Health Fund is distributed to Regions based on an age‐weighting system, while the remainder is allocated based on the unweighted resident population (Ferre et al., 2014). Ireland's health system relies on age, gender, and level of coverage as risk adjusters to determine transfers under risk equalization (Armstrong, 2018); Australian and Chilean risk equalization formulas are based on age, gender, and location (Paolucci et al., 2018; Velasco et al., 2018).…”

Section: Empirical Frameworkmentioning

confidence: 99%

Comparing risk adjustment estimation methods under data availability constraints

et al. 2022

View full text Add to dashboard Cite

The Italian National Healthcare Service relies on per capita allocation for healthcare funds, despite having a highly detailed and wide range of data to potentially build a complex risk‐adjustment formula. However, heterogeneity in data availability limits the development of a national model. This paper implements and ealuates machine learning (ML) and standard risk‐adjustment models on different data scenarios that a Region or Country may face, to optimize information with the most predictive model. We show that ML achieves a small but generally statistically insignificant improvement of adjusted R2 and mean squared error with fine data granularity compared to linear regression, while in coarse granularity and poor range of variables scenario no differences were observed. The advantage of ML algorithms is greater in the coarse granularity and fair/rich range of variables set and limited with fine granularity scenarios. The inclusion of detailed morbidity‐ and pharmacy‐based adjustors generally increases fit, although the trade‐off of creating adverse economic incentives must be considered.

show abstract

“…In addition to statistical models of prediction based on risk adjustor variables, risk sharing (the transfer of some responsibility for costs from a plan to the regulator or the overall insurance market) is a tool for health plan payment (McGuire & Van Kleef, 2018b). Forms of risk sharing are used, among other countries, in the Marketplaces in the United States (Layton et al, 2018), Switzerland (Schmid et al, 2018), and embedded in the plan payment system in Ireland (Armstrong, 2018) and Australia (Paolucci et al, 2018). Researchers have recently found that a modest amount of risk sharing in Israel would substantially reduce incentives for risk selection (Brammli‐Greenberg et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Designing feasible and effective health plan payments in countries with data availability constraints

Henríquez

Iommi

McGuire

et al. 2022

J of Risk & Insurance

View full text Add to dashboard Cite

Risk equalization is a fundamental tool in health plan payment in many countries. Data availability often constrains the feasible models. This paper proposes, implements and quantifies the gains of a risk equalization scheme which incorporates risk sharing in a data poor context. Risk sharing relies on total spending data likely available for purposes of payment, potentially increasing feasibility of an effective payment design. To examine incentives for risk selection, alternative models are evaluated in terms of fit at individual, insurer, and group level. Using Chile's private health insurance market as case study, we show that modest amount of risk sharing greatly improves fit even in simple demographic-based risk equalization.Expanding the model's formula to include morbidity-based adjustors and risk sharing redirects compensations at insurer level and reduces opportunity to engage in profitable risk selection at group level. Our emphasis on feasibility may make alternatives proposed attractive to countries facing data-availability constraints.

show abstract

Health Plan Payment in Ireland

Cited by 3 publications

References 20 publications

Scope and Incentives for Risk Selection in Health Insurance Markets With Regulated Competition: A Conceptual Framework and International Comparison

Scope and Incentives for Risk Selection in Health Insurance Markets With Regulated Competition: A Conceptual Framework and International Comparison

Comparing risk adjustment estimation methods under data availability constraints

Designing feasible and effective health plan payments in countries with data availability constraints

Contact Info

Product

Resources

About