Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems.
Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending.
Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment.
- Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection
- Brings together international experience from many different countries that apply regulated competition in different ways
- Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness
Sprache
Verlagsort
Verlagsgruppe
Elsevier Science & Techn.
ISBN-13
978-0-12-811326-4 (9780128113264)
Schweitzer Klassifikation
1. Regulated Competition in Health Insurance Markets: Paradigms and Ongoing Issues2. Premium Regulation, Risk Equalization, Risk Sharing, and Subsidies: Effects on Affordability and Efficiency3. Risk Adjustment for Health Plan Payment4. Risk Sharing5. Evaluating the Performance of Health Plan Payment Systems6. Health Plan Payment in Australia7. Risk Adjustment in Belgium: Why and How to Introduce Socioeconomic Variables in Health Plan Payment8. Health Plan Payment in Chile9. Health Insurance and Payment System Reform in China10. Health Plan Payment in Colombia11. Health Plan Payment in Germany12. Health Plan Payment in Ireland13. Regulated Competition and Health Plan Payment Under the National Health Insurance Law in Israel-The Unfinished Story14. Health Plan Payment in the Netherlands15. Health Plan Payment in the Russian Federation16. Health Plan Payment in Switzerland17. Health Plan Payment in US Marketplaces: Regulated Competition With a Weak Mandate18. Health Plan Payment in Medicaid Managed Care: A Hybrid Model of Regulated Competition19. Medicare Advantage: Regulated Competition in the Shadow of a Public Option
