Newhouse J P
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Inquiry. 1998 Summer;35(2):122-31.
Risk adjustment is intended to minimize selection of patients or enrollees in health plans. Current efforts generally are recognized as inadequate, but improvement is difficult. The greatest short-term gain will come from introducing diagnostic information, though outpatient diagnosis data are unreliable. Initial efforts may use inpatient data, but this creates incentives to hospitalize people. Even exploiting diagnosis information leaves substantial imperfections. Partial capitation, common in behavioral health, reduces incentives to select patients and stent on services, but current policy resists it, perhaps because policymakers misinterpret the lesson of the Prospective Payment System. Theoretically, not paying plans more for providing additional services is optimal only if consumers are well informed.
风险调整旨在尽量减少健康计划中患者或参保人的选择。目前的努力普遍被认为是不够的，但改进却很困难。最大的短期收益将来自引入诊断信息，尽管门诊诊断数据不可靠。初步努力可能会使用住院数据，但这会产生让人住院的动机。即使利用诊断信息也存在很大缺陷。行为健康领域常见的部分人头付费制减少了选择患者和过度提供服务的动机，但当前政策对此持抵制态度，这可能是因为政策制定者误解了前瞻性支付系统的教训。从理论上讲，只有当消费者充分了解情况时，不为提供额外服务的计划支付更多费用才是最优的。
