@article{5c1202191e534ed0988d36af75554f07,
title = "Integrating risk adjustment and enrollee premiums in health plan payment",
abstract = "In two important health policy contexts - private plans in Medicare and the new state-run {"}Exchanges{"} created as part of the Affordable Care Act (ACA) - plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS).",
keywords = "Exchanges, Health insurance, I13, I18, Medicare, Premiums, Risk adjustment",
author = "McGuire, \{Thomas G.\} and Jacob Glazer and Newhouse, \{Joseph P.\} and Normand, \{Sharon Lise\} and Julie Shi and Sinaiko, \{Anna D.\} and Zuvekas, \{Samuel H.\}",
note = "Funding Information: Research for this paper was supported by the National Institute of Aging ( P01 AG032952 ) and the National Institute of Mental Health ( R01 MH094290 ). This paper represents the views of the authors and no official endorsement by the Agency for Healthcare Research and Quality or the Department of Health and Human Services is intended or should be inferred. We are grateful to Helen Levy and other participants at the “Science of Medicare” meeting at the University of Southern California, January 25–26, 2012. We are also grateful to Sebastian Bauhoff, Randy Ellis, Laura Hatfield and Sara Machado for comments on an earlier draft. ",
year = "2013",
month = dec,
doi = "10.1016/j.jhealeco.2013.05.002",
language = "אנגלית",
volume = "32",
pages = "1263--1277",
journal = "Journal of Health Economics",
issn = "0167-6296",
publisher = "Elsevier B.V.",
number = "6",
}
