Risk adjustment and the fear of markets: the case of Belgium.
In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming.
Schokkaert
E
E
Center for Economic Studies, KU Leuven, Belgium. erik.schokkaert@econ.kuleuven.ac.be
Van de Voorde
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002204:Capitation Fee / Q000458:organization & administration*; D017598:Efficiency, Organizational; D005260:Female; D005380:Financing, Government / Q000458:organization & administration*; D005544:Forecasting; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D015273:Insurance Selection Bias; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008389:Marketing of Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D012044:Regression Analysis; D020379:Risk Adjustment / Q000458:organization & administration*