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Measuring adverse selection in managed health care.

R G Frank1, J Glazer, T G McGuire

  • 1Harvard University, Harvard Medical School, Department of Health Care Policy, Boston, MA 02115, USA. frank@hcp.med.harvard.edu

Journal of Health Economics
|February 24, 2001
PubMed
Summary

Health plans may alter service quality to enroll profitable members. This study identifies factors influencing these "shadow prices" and which services face the most distortion due to enrollment incentives.

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Area of Science:

  • Health economics
  • Healthcare management
  • Health services research

Background:

  • Capitation payment models create incentives for health plans to manage enrollment strategically.
  • Plans may distort service quality to attract low-cost enrollees and deter high-cost ones.

Purpose of the Study:

  • To characterize the rationing of care by health plans as a "shadow price" on access.
  • To identify the determinants of this profit-maximizing shadow price.
  • To develop an index for pinpointing services most affected by selection incentives.

Main Methods:

  • Economic modeling of health plan behavior under capitation.
  • Analysis of how various factors influence rationing decisions.
  • Development of an empirically implementable index.

Main Results:

  • The "shadow price" on care access is influenced by health cost dispersion, individual health cost forecasts, illness correlation, and payment risk adjustment.
  • These factors can be combined into an index to predict service distortion.

Conclusions:

  • Understanding these economic incentives is crucial for regulating health plan behavior.
  • The developed index can guide policy interventions aimed at ensuring equitable access to care.