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. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness

The book pulls together a series of articles by the authors that initiated the research areas of "optimal risk adjustment" and "optimal quality reporting." The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications.

In this volume, leading American health economists provide a critical assessment of the current state of knowledge of insurance market reform that is accessible to both policy-makers and researchers.

Between 1987 and 1991, the portion of Americans covered by individually purchased health insurance dropped 40per cent. Assuming the US will continue to rely on private financing for health care, the author clarifies benefits to society from an efficient health insurance market.

English summary: Auf privatwirtschaftlich organisierten Krankenversicherungsmarkten wird die Pramie entsprechend des individuellen Risikos erhoben. Verschlechtert sich der Gesundheitszustand einer Person, so besteht die Gefahr, dass die Pramie angehoben wird. Die Person sieht sich einer unsicheren Pramie gegenuber. Mathias Kifmann untersucht, wie dieses Pramienrisiko auf wettbewerblich organisierten Krankenversicherungsmarkten versichert werden kann. Drei grundsatzliche Moglichkeiten der Absicherung werden analysiert und verglichen. In einer vertiefenden theoretischen Analyse untersucht der Autor Reformmoglichkeiten der privaten und der gesetzlichen Krankenversicherung. German description: How can it be avoided that consumers face premium risk, i.e. increases in their premiums when their health status deteriorates? Mathias Kifmann examines how this problem which is a major challenge for private health insurance markets can be solved. Three principal ways to insure premium risk which preserve competition among health insurers are analyzed and compared. Guaranteed renewable contracts ensure premiums independent of changes in the health status by requiring a life-time commitment to an insurer. Premium insurance compensates an increase in premiums if the health status changes. Under community rating, the government rules out risk-based premiums by requiring that insurers set a uniform premium for all insured.Mathias Kifmann pays particular attention to the challenges posed by managed care. He argues that managed care can aggravate the lock-in problem under guaranteed renewable contracts. He demonstrates that an alternative contract is superior to guaranteed renewable contracts. This contract creates incentives for insurers to behave in the interest of consumers by specifying payments upon switching to another insurer. If insurers are community-rated, an important question is whether they should be allowed to offer managed care besides traditional health insurance. The author shows that managed care can be used as a pure risk-selection device under community rating. However, the introduction of managed care can also be to the benefit of everyone. To obtain such welfare gains, it may be necessary to tax some insurance plans and to subsidize others.