How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program
How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program
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DOI：
10.1257/aer.104.10.3335
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发表时间：
2014-10-01
影响因子：
10.7
通讯作者：
Woolston, William
中科院分区：
文献类型：
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作者：
Brown, Jason;Duggan, Mark;Woolston, William
为了对抗逆向选择，政府越来越多地根据参保者在风险调整公式中的得分来支付医疗计划和医疗服务提供者的费用。2004年，联邦医疗保险开始对私人医疗保险优势（MA）计划的资本支付进行风险调整，以减少选择驱动的超额支付。但是，由于医疗费用的方差随着预测平均值的增加而增加，激励得分较高的个人入学可以增加招收成本明显低于公式预测的“价格过高”个人的范围。事实上，经过风险调整后，MA计划招收了分数较高但费用较低的个人，条件是他们的分数。我们没有发现任何证据表明超额付款是净减少的。
To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees' scores from risk-adjustment formulae. In 2004, Medicare began to risk-adjust capitation payments to private Medicare Advantage (MA) plans to reduce selection-driven overpayments. But because the variance of medical costs increases with the predicted mean, incentivizing enrollment of individuals with higher scores can increase the scope for enrolling "overpriced" individuals with costs significantly below the formula's prediction. Indeed, after risk adjustment, MA plans enrolled individuals with higher scores but lower costs conditional on their score. We find no evidence that overpayments were on net reduced.