title: Overpaying morbidity adjusters in risk equalization models.
abstract: Most competitive social health insurance markets include risk equalization to compensate insurers for predictable variation in healthcare expenses. Empirical literature shows that even the most sophisticated risk equalization models-with advanced morbidity adjusters-substantially undercompensate insurers for selected groups of high-risk individuals. In the presence of premium regulation, these undercompensations confront consumers and insurers with incentives for risk selection. An important reason for the undercompensations is that not all information with predictive value regarding healthcare expenses is appropriate for use as a morbidity adjuster. To reduce incentives for selection regarding specific groups we propose overpaying morbidity adjusters that are already included in the risk equalization model. This paper illustrates the idea of overpaying by merging data on morbidity adjusters and healthcare expenses with health survey information, and derives three preconditions for meaningful application. Given these preconditions, we think overpaying may be particularly useful for pharmacy-based cost groups.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. vankleef@bmg.eur.nl.
authors.forename: R C
authors.initials: RC
authors.lastname: van Kleef
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
authors.forename: R C J A
authors.initials: RC
authors.lastname: van Vliet
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
authors.forename: W P M M
authors.initials: WP
authors.lastname: van de Ven
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007343:Insurance Carriers / Q000191:economics* / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D009017:Morbidity; D020379:Risk Adjustment / Q000191:economics / Q000458:organization & administration*
keywords: Health insurance; Overpaying; Risk equalization; Risk selection