Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets

Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets
Title Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets PDF eBook
Author Thomas G McGuire
Publisher Academic Press
Pages 0
Release 2018-08-10
Genre Business & Economics
ISBN 9780128113257

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Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment.

The Future of Disability in America

The Future of Disability in America
Title The Future of Disability in America PDF eBook
Author Institute of Medicine
Publisher National Academies Press
Pages 619
Release 2007-10-24
Genre Medical
ISBN 0309104726

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The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.

Employment and Health Benefits

Employment and Health Benefits
Title Employment and Health Benefits PDF eBook
Author Institute of Medicine
Publisher National Academies Press
Pages 381
Release 1993-02-01
Genre Medical
ISBN 0309048273

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The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages. Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices. Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments doâ€"and do not doâ€"to oversee employment-based health programs. A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored. Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care. With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee benefit managers and other executives, trade associations, and decisionmakers in the health insurance industry, as well as analysts, researchers, and students of health policy.

Health-Care Utilization as a Proxy in Disability Determination

Health-Care Utilization as a Proxy in Disability Determination
Title Health-Care Utilization as a Proxy in Disability Determination PDF eBook
Author National Academies of Sciences, Engineering, and Medicine
Publisher National Academies Press
Pages 161
Release 2018-04-02
Genre Medical
ISBN 030946921X

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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Social Reinsurance

Social Reinsurance
Title Social Reinsurance PDF eBook
Author David M. Dror
Publisher World Bank Publications
Pages 548
Release 2002-01-01
Genre Business & Economics
ISBN 9780821350416

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Annotation This volume views community-based microinsurance as an incremental first step to improved financial protection and better access to health services for the poor. While community-based financing can be structured in various ways, this volume focuses on reinsurance as a mechanism for improving micro-level health insurance units. It outlines strategies and policies that can be applied by countries and donors to improve access to health care services.

Reinsurance, Repayments, and Risk Adjustment in Individual Health Insurance

Reinsurance, Repayments, and Risk Adjustment in Individual Health Insurance
Title Reinsurance, Repayments, and Risk Adjustment in Individual Health Insurance PDF eBook
Author Thomas G. McGuire
Publisher
Pages
Release 2018
Genre
ISBN

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Reinsurance can complement risk adjustment of health plan payments to improve fit of payments to plan spending at the individual and group level. This paper proposes three improvements in health plan payment systems using reinsurance. First, we base reinsurance payments on spending not accounted for by the risk adjustment system, rather than just high spending. Second, we propose pairing reinsurance for individual-level losses with repayments for individual-level profits. Third, we optimize the weights on the risk adjustors taking account of the presence of reinsurance/repayment. We implement our methodology in data from Germany, The Netherlands and the U.S. Marketplaces, comparing our modified approach to plan payment with risk adjustment as currently practiced in the three settings. The combination of the three improvements yields very substantial improvements in the individual-level fit of payments to plan spending in all three countries.

Healthcare Risk Adjustment and Predictive Modeling

Healthcare Risk Adjustment and Predictive Modeling
Title Healthcare Risk Adjustment and Predictive Modeling PDF eBook
Author Ian G. Duncan
Publisher ACTEX Publications
Pages 350
Release 2011
Genre Business & Economics
ISBN 1566987695

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This text is listed on the Course of Reading for SOA Fellowship study in the Group & Health specialty track. Healthcare Risk Adjustment and Predictive Modeling provides a comprehensive guide to healthcare actuaries and other professionals interested in healthcare data analytics, risk adjustment and predictive modeling. The book first introduces the topic with discussions of health risk, available data, clinical identification algorithms for diagnostic grouping and the use of grouper models. The second part of the book presents the concept of data mining and some of the common approaches used by modelers. The third and final section covers a number of predictive modeling and risk adjustment case-studies, with examples from Medicaid, Medicare, disability, depression diagnosis and provider reimbursement, as well as the use of predictive modeling and risk adjustment outside the U.S. For readers who wish to experiment with their own models, the book also provides access to a test dataset.