Modest risk-sharing significantly reduces health plans’ incentives for service distortion
Public payers often use payment mechanisms as a way to improve the efficiency of the healthcare system. One source of inefficiency is service distortion (SD) in which health plans over/underprovide services in order to affect the mix of their enrollees. Using Israeli data, we apply a new measure of SD to show that a mixed payment scheme, with a modest level of cost-sharing, yields a significant improvement over a pure risk-adjustment scheme. This observation implies that even though mixed systems induce overprovision of some services, their benefits far outweigh their costs.
KeywordsService distortion Adverse selection Capitation Payment mechanisms Risk-adjustment Risk-sharing Managed care Managed competition
JEL ClassificationI13 I18
An earlier version of this paper was presented at the Risk-Adjustment Network Workshop held in October 2016 in Berlin, Germany. The authors are especially grateful to Konstantin Beck, Randall Ellis, Timothy Layton, Thomas McGuire, Amir Shmueli, Wynand Van de Ven, Richard Van Kleef, and other participants in the workshop for their helpful comments and advice. The authors are also grateful to Glied Sherry, Altman Stuart, Freed Gary and Wittenberg Raphael for their constructive suggestions. This study was funded by a Grant provided by the Israel National Institute for Health Policy Research (Grant number 2012/37).
Compliance with ethical standard
Conflict of interest
The authors declare no potential conflict of interest.
- 1.Layton, T.J., Ellis, R.P., McGuire, T.G.: Assessing Incentives for Adverse Selection in Health Plan Payment Systems. National Bureau of Economic Research (No. w21531) (2015)Google Scholar
- 9.Breyer, F., Bundorf, K., Pauly, M.V.: Health care spending risk, health insurance, and payment to health plans. In: Pauly McGuire, T.G., Barros, P. (eds.) The Handbook of Health Economic, vol. 2, pp. 691–762. Elsevier, Oxford (2012)Google Scholar
- 11.Van de Ven, W.P.M.M., Ellis, R.P.: Risk-adjustment in competitive health plan markets. In: Ellis, R.P. (ed.) Handbook of Health Economics, vol. 1, pp. 755–845. Elsevier, New York (2000)Google Scholar
- 17.Newhouse, J.P.: Reimbursing health plans and health providers: efficiency in production versus selection. J. Econ. Lit. 1996, 1236–1263 (1996)Google Scholar
- 19.McGuire, T., van Kleef, R. (eds.): Risk-adjustment, Risk-sharing and Premium Regulation in Health Insurance Markets: Theory and Practice. Elsevier, New York (2018)Google Scholar
- 21.Van de Ven, W.P., Beck, K., Buchner, F., Schokkaert, E., Schut, F.E., Shmueli, A., Wasem, J.: Preconditions for efficiency and affordability in competitive healthcare markets: are they fulfilled in Belgium, Germany, Israel, The Netherlands and Switzerland? Health Policy 109(3), 226–245 (2013)CrossRefGoogle Scholar
- 26.Brammli-Greenberg, S., Glazer, J., Shmueli, A.: Regulated competition and health plan payment under the national health insurance law in Israel—the unfinished story. Risk-Adjustment, Risk-Sharing and Premium Regulation in Health Insurance Markets, pp. 365–395. Academic Press, New York (2018)CrossRefGoogle Scholar
- 28.Hadley, J., Rosen, B., Shmueli, A.: Towards the inclusion of a health status parameter in the israeli capitation formula. RR-372-02. Myers-JDC Brookdale Institute, Jerusalem Israel (2002)Google Scholar