Does service-level spending show evidence of selection across health plan types?

作者：Randall P. Ellis, Shenyi Jiang, Tzu‐Chun Kuo · 发表于：Applied Economics · 年份：2012 · DOI：10.1080/00036846.2011.636023 · 被引用次数：26 · 研究领域：Healthcare Policy and Management、Global Health Care Issues、Health Systems, Economic Evaluations, Quality of Life

We provide an explanation for the widespread finding that capitated managed care plans attract comparatively healthy, low cost enrollees relative to traditional unmanaged plans. Using disaggregated commercial insurance claims from the Thomson-Reuters MarketScan database, we show that managed care plans spend proportionally less on those types of services that are predicted to be more profitable to ration tightly using a selection index developed by Ellis and McGuire that captures the derivative of profits with respect to reduced spending on disaggregated services. Conventional diagnosis-based risk adjusted premiums reduce selection incentives by about 50% relative to premiums that are not risk-adjusted.