How profitable is risk selection? A comparison of four risk adjustment models.
To mitigate selection triggered by capitation payments, risk-adjustment models bring capitation payments closer on average to individuals' expected expenditure. We examine the maximum potential profit that plans could hypothetically gain by using their own private information to select low-cost enrollees when payments are made using four commonly used risk adjustment models. Simulations using a privately insured sample suggest that risk selection profits remain substantial. The magnitude of potential profit varies according to the risk adjustment model and the private information plans can employ to identify profitable enrollees.
Shen
Yujing
Y
Department of Health Services, Boston University School of Public Health, USA.
Ellis
Randall P
RP
D000206:Actuarial Analysis; D000367:Age Factors; D002204:Capitation Fee; D003625:Data Collection; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D015273:Insurance Selection Bias; D008297:Male; D017059:Models, Econometric; D020379:Risk Adjustment / Q000191:economics*; D012737:Sex Factors; D014481:United States