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对R在风险均等化研究中的应用的批判性综述。

A critical review of the use of R in risk equalization research.

作者信息

van de Ven Wynand P M M, van Kleef Richard C

机构信息

Erasmus University Rotterdam / Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, The Netherlands.

出版信息

Eur J Health Econ. 2025 Apr;26(3):363-375. doi: 10.1007/s10198-024-01709-8. Epub 2024 Aug 9.

DOI:10.1007/s10198-024-01709-8
PMID:39120657
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11937047/
Abstract

Nearly all empirical studies that estimate the coefficients of a risk equalization formula present the value of the statistical measure R. The R-value is often (implicitly) interpreted as a measure of the extent to which the risk equalization payments remove the regulation-induced predictable profits and losses on the insured, with a higher R-value indicating a better performance. In many cases, however, we do not know whether a model with R = 0.30 reduces the predictable profits and losses more than a model with R = 0.20. In this paper we argue that in the context of risk equalization R is hard to interpret as a measure of selection incentives, can lead to wrong and misleading conclusions when used as a measure of selection incentives, and is therefore not useful for measuring selection incentives. The same is true for related statistical measures such as the Mean Absolute Prediction Error (MAPE), Cumming's Prediction Measure (CPM) and the Payment System Fit (PSF). There are some exceptions where the R can be useful. Our recommendation is to either present the R with a clear, valid, and relevant interpretation or not to present the R. The same holds for the related statistical measures MAPE, CPM and PSF.

摘要

几乎所有估计风险均等化公式系数的实证研究都会给出统计量R的值。R值通常(隐含地)被解释为风险均等化支付消除监管导致的被保险人可预测利润和损失的程度的一种度量,R值越高表明表现越好。然而,在许多情况下,我们并不知道R = 0.30的模型是否比R = 0.20的模型能更多地减少可预测的利润和损失。在本文中,我们认为在风险均等化的背景下,R很难被解释为选择激励的度量,当用作选择激励的度量时可能会导致错误和误导性的结论,因此对于衡量选择激励并无用处。对于相关的统计量,如平均绝对预测误差(MAPE)、卡明预测度量(CPM)和支付系统拟合度(PSF)也是如此。存在一些R可能有用的例外情况。我们的建议是要么对R给出清晰、有效且相关的解释后再呈现,要么就不呈现R。对于相关统计量MAPE、CPM和PSF也是如此。