van Kleef Richard C, Reuser Mieke, Stam Pieter J A, van de Ven Wynand P M M
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Erasmus Centre for Health Economics Rotterdam (EsCHER), Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands.
National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands.
Health Econ Rev. 2024 Jul 24;14(1):57. doi: 10.1186/s13561-024-00540-4.
Many health insurance markets are organized by principles of regulated competition. Regulators of these markets typically apply risk equalization (aka risk adjustment) and risk sharing to mitigate risk selection. Risk equalization and risk sharing can have various positive and negative effects on efficiency and fairness. This paper provides a comprehensive framework for ex-ante evaluation of these effects. In a first step, we distinguish 22 potential effects. In a second step, we summarize and discuss quantitative measures used for evaluating risk equalization and risk sharing schemes in academic research. To underline the relevance of our work, we compare our framework with an existing framework that was previously used in the Dutch regulated health insurance market. We conclude that this framework is incomplete and uses inappropriate measures. To avoid suboptimal policy choices, we recommend policymakers (1) to consider the entire spectrum of potential effects and (2) to select their measures carefully.
许多医疗保险市场是按照规范竞争原则组织起来的。这些市场的监管机构通常采用风险均等化（又称风险调整）和风险分担来减轻风险选择。风险均等化和风险分担对效率和公平可能会产生各种正面和负面影响。本文提供了一个用于对这些影响进行事前评估的综合框架。第一步，我们区分出22种潜在影响。第二步，我们总结并讨论了学术研究中用于评估风险均等化和风险分担方案的量化措施。为强调我们工作的相关性，我们将我们的框架与先前在荷兰规范医疗保险市场中使用的现有框架进行了比较。我们得出结论，该框架不完整且使用了不恰当的措施。为避免次优的政策选择，我们建议政策制定者：（1）考虑潜在影响的整个范围；（2）谨慎选择他们的措施。
