Risk adjustment and risk sharing: the Israeli experience.
Israel, like several other countries, introduced a national risk adjusted capitation system during the 1990s. However, the Israeli move was drastic, implementing from the beginning a fully prospective risk adjustment scheme based on age, supplemented by a 100% five condition-specific risk sharing. That scheme, together with open enrollment (periodic switching options), was intended to transform an unregulated competitive health insurance market, characterized by adverse selection and preferred risk selection, into managed competition assuring quality of care, efficiency and fairness. This paper presents the Israeli experience during the first 6 years of the reformed system, focusing on issues related to the risk adjustment and risk sharing arrangements.
Shmueli
Amir
A
Department of Health Management, The Hebrew University-Hadassah School of Public Health, POB 12272, Jerusalem 91120, Israel. ashmueli@md2.huji.ac.il
Chernichovsky
Dov
D
Zmora
Irit
I
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002204:Capitation Fee; D002648:Child; D002675:Child, Preschool; D018166:Health Care Reform / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015273:Insurance Selection Bias; D007557:Israel; D018854:Managed Competition / Q000191:economics*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011445:Prospective Payment System; D020379:Risk Adjustment / Q000379:methods*; D020414:Risk Sharing, Financial / Q000379:methods*; D019472:Universal Health Insurance