Zhu Jane M, Layton Timothy, Sinaiko Anna D, McGuire Thomas G
University of California San Francisco, San Francisco, CA, USA and Harvard Medical School, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Inquiry. 2013 Nov;50(4):255-74. doi: 10.1177/0046958014538913.
Risk adjustment and reinsurance protect plans against risk of losses and contend with adverse selection in the new health insurance Exchanges. This article assesses the power of reinsurance in the context of other plan payment features, including prospective and concurrent risk adjustment. Using data from the Medicare Expenditure Panel Survey (MEPS) to draw an "Exchange population," we simulate the contribution of reinsurance to improving the fit of the payment system to plan costs and to mitigating incentives for adverse selection for groups of enrollees with selected chronic illnesses. Modest reductions in attachment points equate the payment-system fit of retrospective to concurrent risk adjustment. Reinsurance is very powerful in fitting payments to costs and moderately effective in dealing with selection incentives.
风险调整和再保险可保护保险计划免受损失风险，并应对新医疗保险交易所中的逆向选择问题。本文在其他计划支付特征（包括前瞻性和同期风险调整）的背景下评估再保险的作用。利用医疗保险支出小组调查（MEPS）的数据来构建一个“交易所人群”，我们模拟了再保险在改善支付系统与计划成本的匹配度以及减轻对患有特定慢性病的参保人群的逆向选择激励方面的贡献。适度降低起赔点可使追溯性风险调整与同期风险调整在支付系统匹配度上持平。再保险在使支付与成本相匹配方面非常有效，在应对选择激励方面也有一定效果。
