Risk adjustment systems, that reallocate funds among competing health insurers, often use risk adjustors that are based on utilization documented in medical claims. The level of utilization that triggers an adjustor, i.e. the utilization threshold, is frequently chosen implicitly and uniformly. I empirically study utilization thresholds in the setting of the U.S. Marketplaces. Simulat-ing alternative levels of thresholds for adjustors, I find thresholds that improve the prediction fit, by up to 9.6% in some disease groups. Using newly-defined measures for the incentives to game the system, I show that for some thresholds a tradeoff between fit and gaming-incentives does not exist. To guide a choice of multiple utilization thresholds, I employ a regression tree algorithm that considers both fit and gaming incentives.
{"title":"Utilization Thresholds in Risk Adjustment Systems","authors":"Eran Politzer","doi":"10.1086/724791","DOIUrl":"https://doi.org/10.1086/724791","url":null,"abstract":"Risk adjustment systems, that reallocate funds among competing health insurers, often use risk adjustors that are based on utilization documented in medical claims. The level of utilization that triggers an adjustor, i.e. the utilization threshold, is frequently chosen implicitly and uniformly. I empirically study utilization thresholds in the setting of the U.S. Marketplaces. Simulat-ing alternative levels of thresholds for adjustors, I find thresholds that improve the prediction fit, by up to 9.6% in some disease groups. Using newly-defined measures for the incentives to game the system, I show that for some thresholds a tradeoff between fit and gaming-incentives does not exist. To guide a choice of multiple utilization thresholds, I employ a regression tree algorithm that considers both fit and gaming incentives.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48791170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Impact of Modest Cash Incentives on Home Visiting Enrollment and Participation","authors":"Robin Jacob, Megan Foster Friedman","doi":"10.1086/724793","DOIUrl":"https://doi.org/10.1086/724793","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"1 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41514781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Front Matter","authors":"","doi":"10.1086/725650","DOIUrl":"https://doi.org/10.1086/725650","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134956667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Realization of Low Probability Clinical Risks and Physician Behavior: Evidence from Primary Care Physicians","authors":"Yoav Goldstein, G. Chodick, Ity Shurtz","doi":"10.1086/724416","DOIUrl":"https://doi.org/10.1086/724416","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46104550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tamás Hajdu, G. Kertesi, G. Kézdi, Á. Szabó‐Morvai
{"title":"The Effects of Neonatal Intensive Care on Infant Mortality and Long-Term Health Impairments","authors":"Tamás Hajdu, G. Kertesi, G. Kézdi, Á. Szabó‐Morvai","doi":"10.1086/724219","DOIUrl":"https://doi.org/10.1086/724219","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48470369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cheng Chen, Shin-Yi Chou, Hsien-Ming Lien, Jin-Tan Liu
{"title":"The Long-Term Health Effects of Early-Life Malaria Exposure: Evidence from Taiwan's Malaria Eradication in the 1950s","authors":"Cheng Chen, Shin-Yi Chou, Hsien-Ming Lien, Jin-Tan Liu","doi":"10.1086/724216","DOIUrl":"https://doi.org/10.1086/724216","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45666446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-03-29DOI: 10.1086/722982
Silvia Helena Barcellos, Mireille Jacobson, Helen G Levy
We use a regression discontinuity design to understand the impact of a sharp change in eligibility for Medicaid versus subsidized marketplace insurance at 138 percent of the federal poverty line on coverage, medical spending, health status, and other public program participation. We find a 5.5 percentage point shift from Medicaid to private insurance, with no net change in coverage. The shift increases individual health spending by $341 or 2 percent of income, with larger increases at higher points in the spending distribution. Two-thirds of the increase is from premiums and one-thirdfrom out-of-pocket medical spending. Self-rated health and other public program participation appear unchanged. We find no evidence of bunching below the eligibility threshold, which suggests either that individuals are willing to pay more for private insurance or that optimization frictions are high.
{"title":"THE IMPACT OF ELIGIBILITY FOR MEDICAID VERSUS SUBSIDIZED PRIVATE HEALTH INSURANCE ON MEDICAL SPENDING, SELF-REPORTED HEALTH, AND PUBLIC PROGRAM PARTICIPATION.","authors":"Silvia Helena Barcellos, Mireille Jacobson, Helen G Levy","doi":"10.1086/722982","DOIUrl":"10.1086/722982","url":null,"abstract":"<p><p>We use a regression discontinuity design to understand the impact of a sharp change in eligibility for Medicaid versus subsidized marketplace insurance at 138 percent of the federal poverty line on coverage, medical spending, health status, and other public program participation. We find a 5.5 percentage point shift from Medicaid to private insurance, with no net change in coverage. The shift increases individual health spending by $341 or 2 percent of income, with larger increases at higher points in the spending distribution. Two-thirds of the increase is from premiums and one-thirdfrom out-of-pocket medical spending. Self-rated health and other public program participation appear unchanged. We find no evidence of bunching below the eligibility threshold, which suggests either that individuals are willing to pay more for private insurance or that optimization frictions are high.</p>","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"262-295"},"PeriodicalIF":3.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43324378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：