Luft H S
Institute for Health Policy Studies, School of Medicine, University of California, San Francisco 94109, USA.
Inquiry. 1995 Spring;32(1):23-32.
Risk differences are inherent with voluntary enrollment or choice of health plans. If these desirable features are to be maintained, risk differences must be assessed and payments to plans adjusted. Perfect prediction of individual level costs is impossible, but it is feasible to approximate costs for large groups of employees joining a purchasing cooperative. When people within an employee group or cooperative can choose among different health plans, there is much more opportunity for risk selection. A fair but powerful referee to determine adjustment methods within the cooperative's zero-sum setting may reduce markedly the potential for selection problems.
风险差异与自愿参保或健康计划的选择相伴而生。若要维持这些理想特征，就必须评估风险差异并调整对各计划的支付。对个体层面的成本进行完美预测是不可能的，但对加入采购合作社的大批员工的成本进行估算则是可行的。当员工群体或合作社内部的人员能够在不同的健康计划中进行选择时，风险选择的机会就会多得多。在合作社的零和环境中，一个公平且有力的裁判来确定调整方法，可能会显著降低出现选择问题的可能性。
