Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice

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 selectionBrings together international experience from many different countries that apply regulated competition in different waysDelivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness

1. Regulated Competition in Health Insurance Markets: Paradigms and Ongoing Issues 2. Premium Regulation, Risk Equalization, Risk Sharing, and Subsidies: Effects on Affordability and Efficiency 3. Risk Adjustment for Health Plan Payment 4. Risk Sharing 5. Evaluating the Performance of Health Plan Payment Systems 6. Health Plan Payment in Australia 7. Risk Adjustment in Belgium: Why and How to Introduce Socioeconomic Variables in Health Plan Payment 8. Health Plan Payment in Chile 9. Health Insurance and Payment System Reform in China 10. Health Plan Payment in Colombia 11. Health Plan Payment in Germany 12. Health Plan Payment in Ireland 13. Regulated Competition and Health Plan Payment Under the National Health Insurance Law in Israel—The Unfinished Story 14. Health Plan Payment in the Netherlands 15. Health Plan Payment in the Russian Federation 16. Health Plan Payment in Switzerland 17. Health Plan Payment in US Marketplaces: Regulated Competition With a Weak Mandate 18. Health Plan Payment in Medicaid Managed Care: A Hybrid Model of Regulated Competition 19. Medicare Advantage: Regulated Competition in the Shadow of a Public Option