{"title":"荷兰基本健康保险的选择激励:临终支出在多大程度上有助于选择性群体的可预测利润和损失?","authors":"A A Withagen-Koster, R C van Kleef, F Eijkenaar","doi":"10.1177/10775587221099731","DOIUrl":null,"url":null,"abstract":"<p><p>Existing risk-equalization models in individual health insurance markets with premium-rate restrictions do not completely compensate insurers for predictable profits/losses, confronting insurers with risk selection incentives. To guide further improvement of risk-equalization models, it is important to obtain insight into the drivers of remaining predictable profits/losses. This article studies a specific potential driver: end-of-life spending (defined here as spending in the last 1-5 years of life). Using administrative (<i>N</i> = 16.9 m) and health survey (<i>N</i> = 384 k) data from the Netherlands, we examine the extent to which end-of-life spending contributes to predictable profits/losses for selective groups. We do so by simulating the predictable profits/losses for these groups with and without end-of-life spending while correcting for the overall spending difference between these two situations. Our main finding is that-even under a sophisticated risk-equalization model-end-of-life spending can contribute to predictable losses for specific chronic conditions.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606011/pdf/","citationCount":"0","resultStr":"{\"title\":\"Selection Incentives in the Dutch Basic Health Insurance: To What Extent Does End-of-Life Spending Contribute to Predictable Profits and Losses for Selective Groups?\",\"authors\":\"A A Withagen-Koster, R C van Kleef, F Eijkenaar\",\"doi\":\"10.1177/10775587221099731\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Existing risk-equalization models in individual health insurance markets with premium-rate restrictions do not completely compensate insurers for predictable profits/losses, confronting insurers with risk selection incentives. To guide further improvement of risk-equalization models, it is important to obtain insight into the drivers of remaining predictable profits/losses. This article studies a specific potential driver: end-of-life spending (defined here as spending in the last 1-5 years of life). Using administrative (<i>N</i> = 16.9 m) and health survey (<i>N</i> = 384 k) data from the Netherlands, we examine the extent to which end-of-life spending contributes to predictable profits/losses for selective groups. We do so by simulating the predictable profits/losses for these groups with and without end-of-life spending while correcting for the overall spending difference between these two situations. Our main finding is that-even under a sophisticated risk-equalization model-end-of-life spending can contribute to predictable losses for specific chronic conditions.</p>\",\"PeriodicalId\":51127,\"journal\":{\"name\":\"Medical Care Research and Review\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606011/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medical Care Research and Review\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10775587221099731\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Care Research and Review","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10775587221099731","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Selection Incentives in the Dutch Basic Health Insurance: To What Extent Does End-of-Life Spending Contribute to Predictable Profits and Losses for Selective Groups?
Existing risk-equalization models in individual health insurance markets with premium-rate restrictions do not completely compensate insurers for predictable profits/losses, confronting insurers with risk selection incentives. To guide further improvement of risk-equalization models, it is important to obtain insight into the drivers of remaining predictable profits/losses. This article studies a specific potential driver: end-of-life spending (defined here as spending in the last 1-5 years of life). Using administrative (N = 16.9 m) and health survey (N = 384 k) data from the Netherlands, we examine the extent to which end-of-life spending contributes to predictable profits/losses for selective groups. We do so by simulating the predictable profits/losses for these groups with and without end-of-life spending while correcting for the overall spending difference between these two situations. Our main finding is that-even under a sophisticated risk-equalization model-end-of-life spending can contribute to predictable losses for specific chronic conditions.
期刊介绍:
Medical Care Research and Review (MCRR) is a peer-reviewed bi-monthly journal containing critical reviews of literature on organizational structure, economics, and the financing of health and medical care systems. MCRR also includes original empirical and theoretical research and trends to enable policy makers to make informed decisions, as well as to identify health care trends. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 25 days