Risk equalization in The Netherlands: an empirical evaluation

References

• Van de Ven WPMM, Ellis RP. Risk adjustment in competitive health insurance markets. In: Handbook of Health Economics. Culyer AJ, Newhouse JP ( Eds). Elsevier, Amsterdam, The Netherlands, 755–845 (2000).
   Google Scholar
• Newhouse JP. Reimbursing health plans and health providers: efficiency in production versus selection. J. Econ. Lit. 34, 1236–1263 (1996).
   Web of Science ®Google Scholar
• Van de Ven WPMM, Schut FT. Guaranteed access to affordable coverage in individual health insurance markets. In: The Oxford Handbook of Health Economics. Glied S, Smith PC ( Eds) Oxford University Press, Oxford, UK, 380–404 (2011).
   Google Scholar
• Hornbrook MC, Goodman MJ. Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment. Health Serv. Res. 31, 283–307 (1996).
   PubMed Web of Science ®Google Scholar
• Pope GC, Adamache KW, Walsh EG et al. Evaluating alternative risk adjusters for medicare. Health Care Financ. Rev. 20, 109–129 (1998).
   Google Scholar
• Lamers LM. Risk-adjusted capitation based on the diagnostic cost group model: an empirical evaluation with health survey information. Health Serv. Res. 33, 1727–1744 (1999).
   PubMed Web of Science ®Google Scholar
• Noyes K, Hangsheng L, Temkin-Greener H. Medicare capitation model, functional status and multiple comorbidities: model accuracy. Am. J. Manag. Care 14, 679–690 (2008).
   Google Scholar
• Kautter J, Ingber M, Pope GC. Medicare risk adjustment for the frail elderly. Health Care Financ. Rev. 30, 83–93 (2009).
   Google Scholar
• Stam PJ, Van Vliet RCJA, Van de Ven WPMM. Diagnostic, pharmacy-based, and self-reported health measures in risk equalization models. Med. Care 48, 448–457 (2010).
   PubMed Web of Science ®Google Scholar
• Lamers LM. Pharmacy costs groups: a risk adjuster for capitation payments based on the use of prescribed drugs. Med. Care 37, 824–830 (1999).
   PubMed Web of Science ®Google Scholar
• Lamers LM. Risk-adjusted capitation payments: developing a diagnostic cost groups classification for the dutch situation. Health Policy 45, 15–32 (1998).
   Google Scholar
• Prinsze FJ, Van Vliet RCJA, Health-based risk adjustment: improving the pharmacy-based cost group model by adding diagnostic cost groups. Inquiry 44, 469–480 (2007).
   Google Scholar
• Van Kleef RC, Van Vliet RCJA. Improving risk equalization using multiple-year high cost as a health indicator. Med. Care 50, 140–144 (2012).
   Google Scholar
• Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med. Care 34, 220–233 (1996).
   PubMed Web of Science ®Google Scholar
• McWhinnie JR. Disability assessment in population surveys: results of the OECD Common Development Effort. Rev. Epidemiol. Sante. Publique 29, 413–419(1981).
   PubMed Web of Science ®Google Scholar
• Van Kleef RC, Van Vliet RCJA. Prior use of durable medical equipment as a risk adjuster for health-based capitation. Inquiry 47, 343–358 (2011).
   Google Scholar
• Buchner F, Goepffarth D, Wasem J. The new risk adjustment formula in Germany: implementation and first experiences. Health Policy 109, 253–262 (2013).
   PubMed Web of Science ®Google Scholar
• Winkelman R, Mehmud S. A comparative Analysis of Claims-Based Tools for Health Risk Assessment. Research report. Society of Actuaries, Schaumburg, IL, USA (2007).
   Google Scholar
• Pope GC, Kautter J, Ellis RP et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ. Rev. 25, 119–141 (2004).
   PubMed Web of Science ®Google Scholar
• Kronick R, Gilmer T, Dreyfus T et al. Improving health-based payments for Medicaid beneficiaries: CDPS. Health Care Financ. Rev. 21, 29–64 (2000).
   PubMed Web of Science ®Google Scholar
• Weiner JP, Dobson A, Maxwell SL et al. Risk-Adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financ. Rev. 17, 77–100(1996).
   PubMed Web of Science ®Google Scholar
• Hughes JS, Averill RF, Eisenhandler J et al. Clinical Risk Groups (CRGs) – a classification System for risk-adjusted capitation-based payment and health care management. Med. Care 42, 81–90 (2004).
   PubMed Web of Science ®Google Scholar
• Van Barneveld EM, Lamers LM, Van Vliet RCJA, Van de Ven WPMM. Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market. Soc. Sci. Med. 47, 223–232 (1998).
   Google Scholar
• Van Barneveld EM, Lamers LM, Van Vliet RCJA, Van de Ven WPMM. Risk sharing as a supplement to imperfect capitation: a trade-off between selection and efficiency. J. Health Econ. 20, 147–168(2001).
   Google Scholar
• Van Kleef RC, Beck K, Buchner F. Risk-type concentration and efficiency incentives: a challenge for the risk adjustment formula. The Geneva Papers 35, 503–520 (2010).
   Google Scholar
• Stam PJA, Van Vliet RCJA, Van de Ven WPMM. A limited-sample benchmark approach to assess and improve the performance of risk equalization models. J. Health Econ. 29, 426–437.
   Google Scholar
• Schokkaert E, Dhaene G, Van de Voorde C. Risk adjustment and the trade-off between efficiency and risk selection: an application of the theory of fair compensation. Health Econ. 7, 465–480 (1998).
   Web of Science ®Google Scholar
• Van Kleef RC, Van Vliet RCJA, Van Rooijen EM. Diagnoses-based cost groups in the Dutch risk-equalization model: The effects of including outpatient diagnoses. Health Policy doi:10.1016/j.healthpol.2013.07.005 (2013) ( Epub ahead of print).
   Google Scholar
• Van Kleef RC, Van Vliet RCJA, Van de Ven WPMM. Risicoverevening 2012: Een Analyse van Voorspelbare Winsten en Verliezen op Subgroepniveau. ( English Translation: Risk Equalization 2012: An Analysis of Predictable Profits and Losses at Subgroup Level.) Research Report (in Dutch), Erasmus University Rotterdam, Rotterdam, The Netherlands (2013).
   Google Scholar