Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Health Serv Res. 2019 Apr;54(2):455-465. doi: 10.1111/1475-6773.13065. Epub 2018 Oct 16.
To study the extent to which risk equalization (RE) in competitive health insurance markets can be improved by including an indicator for being healthy.
STUDY SETTING/DATA SOURCES: This study is conducted in the context of the Dutch individual health insurance market. Administrative data on spending and risk characteristics (2011-2014) for the entire population (N = 16.6 m) as well as health survey data from a large sample (N = 387 k) are used.
The indicator for being healthy is low spending in three consecutive prior years. "Low spending" is defined in three ways: belonging to the bottom 60%, 70%, or 80% of the annual spending distribution. Versions of the Dutch RE model 2017 with and without the indicator are compared on individual-level payment fit and, using the survey data, group-level payment fit.
All three alternative models outperform the Dutch RE model 2017. However, significant unpriced risk heterogeneity remains. Compared with the 60% threshold, the 80% threshold comes with a larger improvement in fit but identifies a less selective group.
The performance of the RE model can be improved by adding an indicator for being healthy based on multiple-year low spending. However, risk-selection potential remains, warranting high priority to further improvement of RE.
研究在竞争健康保险市场中，通过纳入健康指标，风险均等化（RE）可以在多大程度上得到改善。
研究背景/数据来源：本研究在荷兰个人健康保险市场的背景下进行。使用了关于整个人群（N=1660 万）支出和风险特征的管理数据（2011-2014 年），以及来自大样本（N=38.7 万）的健康调查数据。
健康指标是连续三年的低支出。“低支出”以三种方式定义：属于年度支出分布的底部 60%、70%或 80%。比较了带有和不带有该指标的 2017 年荷兰 RE 模型在个体层面支付拟合度上的差异，并利用调查数据评估了群体层面支付拟合度。
所有三种替代模型的表现均优于 2017 年荷兰 RE 模型。然而，仍存在显著的未定价风险异质性。与 60%的阈值相比，80%的阈值在拟合度方面有更大的提高，但确定了一个选择性较低的群体。
通过基于多年低支出的健康指标，可以提高 RE 模型的性能。然而，风险选择的潜力仍然存在，因此需要高度优先考虑进一步改进 RE。
