Risk adjustment in health insurance and its long-term effectiveness

Beck, Konstantin; Trottmann, Maria; Zweifel, Peter

doi:10.1016/j.jhealeco.2010.03.009

Cited by 50 publications

(25 citation statements)

References 20 publications

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“…Despite the reform of risk adjustment accepted in 2007, but implemented only in 2012 [3], the 61 insurers still compete in terms of selecting good risks instead of improving services, and making extensive use of the selective contracting tools available [4]. The gap between the lowest and the highest premiums offered by different insurers, for the same coverage, in the same region, can therefore exceed 100%.…”

Section: Purpose Of Health Policymentioning

confidence: 99%

Swiss popular initiative for a single health insurer… once again!

Pietro

Crivelli

2015

Health Policy

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The article describes a recent Swiss popular initiative, aiming to replace the current system of statutory health insurance run by 61 competing private insurers with a new system run by a single public insurer. Despite the rejection of the initiative by 62% of voters in late September 2014, the campaign and ballot results are interesting because they show the importance of (effective) public communication in shaping the outcome of a popular ballot. The relevance of the Swiss case goes beyond the peculiarities of its federalism and direct democracy and might be useful for other countries debating the pros and cons of national unitary health insurance systems versus models using multiple insurers. After this electoral ballot, the project to establish a public sickness fund in Switzerland seems definitely stopped, at least for the next decade. Insurers, who opposed the initiative, have effectively fed the "fear of change" of the population and have stressed the good outcomes of the Swiss healthcare system. However, the political pressure favoured by the popular initiative opened a "windows of opportunity" and led the federal Parliament to pass a stricter regulation of health insurers, improving in this way the current system.

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Section: Purpose Of Health Policymentioning

confidence: 99%

Swiss popular initiative for a single health insurer… once again!

Pietro

Crivelli

2015

Health Policy

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“…All four of the variables are lagged (by up to 2 years) so that (ii) and (iii) will only be affected by past practice decisions. Similar variables have been used in models of risk adjustment (Beck, Trottmann, and Zweifel ). Indicators for whether the patient had a private inpatient spell or a privately funded outpatient attendance in an NHS hospital in the previous 2 years. These allow for the fact that patients using private health care might have different characteristics and different propensity to be treated, given their underlying morbidity. …”

Section: Datamentioning

confidence: 99%

Quality of Disease Management and Risk of Mortality in English Primary Care Practices

Dusheiko

Gravelle

Martin

et al. 2015

Health Services Research

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Objective. To investigate whether better management of chronic conditions by family practices reduces mortality risk. Data. Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. Study Design. Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. Principal Findings. Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. Conclusions. The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions.

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“…As a consequence, premiums significantly differ across regions and cantons, reflecting the huge differences in health care expenditures. Significant variation exists also across health insurers [21], due in particular to a still ineffective risk adjustment mechanism [22]. Horizontal equity across geographic communities is not guaranteed at all, since individuals with the same income pay significantly more or less depending on what premium region they are resident in.…”

Section: Swiss Health System Financingmentioning

confidence: 99%

The inequity of the Swiss health care system financing from a federal state perspective

Crivelli

Salari

2014

Int J Equity Health

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IntroductionPrevious studies have shown that Swiss health-care financing is particularly regressive. However, as it has been emphasized in the 2011 OECD Review of the Swiss Health System, the inter cantonal variations of income-related inequities are still broadly unexplored. The present paper aims to fill this gap by analyzing the differences in the level of equity of health-care system financing across cantons and its evolution over time using household data.MethodsFollowing the methodology proposed by Wagstaff et al. (JHE 11:361–387, 1992) we use the Kakwani index as a summary measure of regressivity and we compute it for each canton and for each of the sources that have a role in financing the health care system. We graphed concentration curves and performed relative dominance tests, which utilize the full distribution of expenditures.The microdata come from the Swiss Household Income and Expenditure Survey (SHIES) based on a sample of the Swiss population (about 3500 households per year), for the years 1998 - 2005.ResultsThe empirical evidence confirms that the health-care financing in Switzerland has remained regressive since the major reform of 1996 and shows that the variations in equity across cantons are quite significant: the difference between the most and the least regressive canton is about the same as between two extremely different financing systems like the US and Sweden. There is no evidence, instead, of a clear evolution over time of regressivity.ConclusionsThe significant variation in equity across cantons can be explained by fiscal federalism and the related autonomy in the design of tax and social policies. In particular, the results highlight that earmarked subsidies, the policy adopted to smooth the regressivity of the premiums, appear to be not enough; in the practice of federal states the combination of allowances with mandatory community-rated health insurance premiums might lead to a modest outcome in terms of equity.

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Risk adjustment in health insurance and its long-term effectiveness

Cited by 50 publications

References 20 publications

Swiss popular initiative for a single health insurer… once again!

Swiss popular initiative for a single health insurer… once again!

Quality of Disease Management and Risk of Mortality in English Primary Care Practices

The inequity of the Swiss health care system financing from a federal state perspective

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