van Barneveld E M, van Vliet R C, van de Ven W P
Department of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
Inquiry. 1996 Summer;33(2):133-43.
Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in The Netherlands. Crude RACPs are inadequate, especially because they encourage insurers to select against people expected to be unprofitable--a practice called cream skimming. However, implementing improved RACPs does not appear to be straightforward. This paper analyzes an approach that, given a system of crude RACPs, reduces insurers' incentives for cream skimming in the market for individual health insurance, while preserving incentives for efficiency and cost containment. Under the proposed system of Mandatory High-Risk Pooling (MHRP), each insurer would be allowed to periodically predetermine a small fraction of its members whose costs would be (partially) pooled. The pool would be financed with mandatory, flat-rate contributions. The results suggest that MHRP is a promising supplement to RACPs.
向相互竞争的健康保险公司支付风险调整后的人头费（RACPs）是荷兰以市场为导向的医疗改革的一个基本要素。单纯的RACPs并不充分，特别是因为它们鼓励保险公司选择那些预计无利可图的人群——这种做法被称为撇脂。然而，实施改进后的RACPs似乎并非易事。本文分析了一种方法，即在现有的单纯RACPs系统下，减少保险公司在个人健康保险市场上进行撇脂的动机，同时保留提高效率和控制成本的动机。在提议的强制高风险共担（MHRP）系统下，每家保险公司将被允许定期预先确定一小部分成员，其成本将（部分）进行共担。该共担池将通过强制性的统一费率缴款来融资。结果表明，MHRP是RACPs的一个有前景的补充。
