Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets —— Theory and Practice

----- 健康保险市场中的风险调整，风险分担和溢价监管：理论与实践

ISBN: 9780128113257 出版年：2018 页码：659 Academic Press_RM

Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment.Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selectionBrings together international experience from many different countries that apply regulated competition in different waysDelivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness