ADVERSE SELECTION AND RISK RATING IN INSURANCE MARKETS

这项研究将使用1985-89年的人员数据和来自 大型雇主将制定一种测量和补偿 在相互竞争的健康保险计划中进行逆向选择。六个方程式 医疗服务利用预测的极大似然模型 将使用索赔数据作为因变量来估计支出 以人员数据为自变量。诊断信息 将使用索赔数据来确定特别高的风险 最有可能成为风险选择战略对象的个人；a 将开发各种特殊技术来调整雇主的风险 对这些个人的贡献。将有两组模型参数 估计费用，根据注册人在 雇主的服务费(FFS)计划和以年度支出为基础的计划 对于预付费集团的参与者，请实践健康维护组织 (HMO)拥有很大的市场份额。FFS参数在网络中的应用 HMO投保人和FFS计划投保人的HMO参数将 根据收益生成两种可选的偏向选择方法 两种选择的套餐和练习风格的特点 计划。预计支出也将为参加 雇主提供的几个较小的HMO来衡量逆向选择 在相互竞争的医疗保健组织中。我们将分析预计和实际支出 从FFS计划转到HMO或从一个HMO转到 另一个，并将这些与#年的预测支出和实际支出进行比较 连续参加特定计划的个人。

This study will use 1985-89 personnel data and medical care claims from a large employer to develop a method for measuring and compensating for adverse selection among competing health insurance plans. A six equation maximum likelihood model for predicting medical care utilization and expenditures will be estimated using the claims data as dependent variables and the personnel data as independent variables. Diagnostic information from the claims data will be used to identify particularly high risk individuals most likely to be the objects of risk selection strategies; a variety of special techniques will be developed to risk-adjust employer contributions for these individuals. Two sets of model parameters will be estimated, one based on annual allowed charges incurred by enrollees in the employer's fee-for-service (FFS) plan and one based on annual expenditures for enrollees in a prepaid group practice Health Maintenance Organization (HMO) with a large market share. Application of the FFS parameters to the HMO enrollees and of the HMO parameters to the FFS plan enrollees will generate two alternative measures of biased selection based on the benefit packages and styles of practice characteristic of the two alternative plans. Predicted expenditures will also be generated for enrollees in the several smaller HMOs offered by the employer to measure adverse selection among competing HMOs. We will analyze predicted and actual expenditures for individuals switching from the FFS plan to an HMO or from one HMO to another and compare these to predicted and actual expenditures for individuals continuously enrolled in particular plans.