Health-adjusted premium subsidies in the Netherlands.
The Dutch government has decided to proceed with managed competition in health care. In this paper we report on progress made with health-based risk adjustment, a key issue in managed competition. In 2004 both Diagnostic Cost Groups (DCGs) computed from hospital diagnoses only and Pharmacy-based Cost Groups (PCGs) computed from out-patient prescription drugs are used to set the premium subsidies for competing risk-bearing sickness funds. These health-based risk adjusters appear to be effective and complementary. Risk selection is not a major problem in the Netherlands. Despite the progress made, we are still faced with a full research agenda for risk adjustment in the coming years.
van de Ven
Wynand P M M
WP
Erasmus University Rotterdam, The Netherlands. vandeven@bmg.eur.nl
van Vliet
René C J A
RC
Lamers
Leida M
LM
D005249:Fees and Charges; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D018854:Managed Competition; D009426:Netherlands; D010593:Pharmaceutical Services / Q000191:economics; D020379:Risk Adjustment