Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Managing risk in a risky world.

S R Eastaugh1

  • 1Department of Health Policy and Management, School of Public Health and Health Services, George Washington University, Washington, DC, USA.

Journal of Health Care Finance
|March 27, 1999
PubMed
Summary
This summary is machine-generated.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

Hospital costs and specialization: benefits of trimming product lines.

Journal of health care finance·2001
Same author

National healthcare spending and fiscal control: comparisons among 15 countries.

Hospital topics·2001
Same author

Cost-effective potential for home health care.

Managed care quarterly·2001
Same author

New ventures require accurate risk analyses and adjustments.

Healthcare financial management : journal of the Healthcare Financial Management Association·2000
Same author

Willingness to pay in treatment of bleeding disorders.

International journal of technology assessment in health care·2000
Same author

Financial issues in defining levels for HIV/AIDS research.

Journal of health care finance·1998

Managed care plans need better risk adjustment methods to fairly pay for high-cost patients. A new mixed payment system can improve equity and reward quality care for complex conditions.

Area of Science:

  • Health Economics
  • Healthcare Management
  • Risk Management

Background:

  • Capitation managed care plans face challenges due to slow innovation in risk adjustment.
  • Concerns exist regarding Medicare severity adjustments potentially reducing rates for managed care firms.
  • Current risk prediction methods may lead to discrimination against sick patients and undercare.

Purpose of the Study:

  • To explore the need for retooled insurance risk prediction methods.
  • To advocate for a more equitable marketplace in healthcare.
  • To propose solutions for managing financial risks associated with high-cost patients.

Main Methods:

  • Analysis of current risk adjustment systems in managed care.
  • Discussion of potential impacts of Medicare severity adjustments.

Related Experiment Videos

  • Proposal of a mixed payment system combining capitation and prospective payments.

    • Main Results:

    • Slow innovation in risk adjustment is impacting managed care plan popularity.
    • A new mixed payment system is suggested to address inequities.
    • This system aims to prevent "cream skimming" and reward quality providers.

    Conclusions:

    • Risk adjustment systems require significant innovation to ensure fairness.
    • Payers should invest in developing valid severity adjustment systems.
    • A mixed payment model can create a more equitable system rewarding quality care for complex diseases.