Adverse selection among multiple competing health maintenance organizations.
Adverse selection among multiple competing health maintenance organizations.
复制标题
多个竞争的健康维护组织之间的逆向选择。
DOI：
10.1097/00005650-199512000-00001
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发表时间：
1995
期刊：
影响因子：
3
通讯作者：
Gardner,LB
中科院分区：
文献类型：
--
作者：
Robinson,JC;Gardner,LB
本研究探讨了1989年一家大公司的16，182名员工的9个健康计划之间的风险选择：一个传统的收费服务计划，一个集团模式的健康维护组织（HMO）和7个网络和独立的实践模式的HMO。我们开发和比较的风险措施，使用HMO和收费服务支出数据的基础上的权重。我们使用一个多方程统计模型来开发两套利用率和支出的权重在每个计划的注册。其中一组权重是基于大型团体模型HMO的出院摘要和门诊记录，衡量九组员工和家属中的每一组如果参加严格管理的计划，没有消费者费用分摊，他们会花多少钱。另一组权重基于按服务收费的索赔数据，衡量如果每个群体参加了一个有大量共同保险和免赔额的非管理型健康计划，他们会花多少钱。预测的年度支出每个登记者表现出23%的范围从最低（有利的选择）到最高（不利的选择）的风险计划使用HMO的权重和17%的范围使用收费服务的权重。收费服务计划和团体模式的HMO与大量的注册有风险混合附近的中心频谱。较小的HMO表现出有利选择和不利选择的极端形式。
This study examines risk selection among nine health plans competing for 16,182 employees of one large firm in 1989: one conventional fee-for-service plan, one group-model health maintenance organization (HMO) and seven network and independent practice model HMOs. We develop and compare measures of risk using weights based on HMO and fee-for-service expenditure data, respectively. We use a multiequation statistical model to develop two sets of utilization and expenditure weights for enrollees in each plan. One set of weights, based on discharge abstracts and outpatient records from the large group-model HMO, measures how much each of the nine groups of employees and dependents would have spent, had they been enrolled in a stringently managed plan with no consumer cost sharing. The other set of weights, based on fee-for-service claims data, measures how much each group would have spent, had it been enrolled in an unmanaged health plan with significant coinsurance and deductibles. Predicted annual expenditures per enrollee exhibit a 23% range from lowest (favorable selection) to highest (adverse selection) risk plans using the HMOweights and a 17% range using fee-for-service weights. The fee-for-service plan and group-model HMO with large enrollments have risk mixes near the center of the spectrum. Smaller HMOs exhibit the extreme forms of both favorable and adverse selection.