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

How profitable is risk selection? A comparison of four risk adjustment models.

Yujing Shen1, Randall P Ellis

  • 1Department of Health Services, Boston University School of Public Health, USA.

Health Economics
|March 29, 2002
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

Imitation learning and co-presence learning influence the acquisition of word formation rules: A fNIRS hyperscanning study.

NeuroImage·2025
Same author

Associations between triglyceride-glucose-related indices and all-cause and cardiovascular mortality among individuals with atrial fibrillation and metabolic syndrome: a cohort study of the UK biobank.

Cardiovascular diabetology·2025
Same author

SIRT1 Attenuates Neuropathic Pain via CDK5-Kalirin-7 Signaling Pathway in Type 2 Diabetic Rats.

Molecular neurobiology·2025
Same author

Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care.

JAMA network open·2025
Same author

Factors Associated With Semaglutide Initiation Among Adults With Obesity.

JAMA network open·2025
Same author

Co-learning companionship benefits word learning in a new language: Evidence from a dual-brain EEG examination.

Cerebral cortex (New York, N.Y. : 1991)·2024
Same journal

Health on the Move: The Impact of Poverty Alleviation Relocation on Healthcare Utilization in China.

Health economics·2026
Same journal

The Effects of Compulsory Licensing: A Case Study of HIV Drugs.

Health economics·2026
Same journal

Beyond Tobacco Prevention: The Effects of Tobacco 21 Laws on Young Adults' Body Weight.

Health economics·2026
Same journal

Assessing the Estimands and Estimates of Hospitalization Rates in Health Economics and Clinical Medicine.

Health economics·2026
Same journal

The Impact of Unemployment Insurance Benefit Cuts on Mental Health: Evidence From Early Pandemic Program Expirations.

Health economics·2026
Same journal

Do Patients Value the Service Provided by Physicians Who Overbill? A Willingness-to-Pay Study Using French Survey Data.

Health economics·2026
See all related articles

Risk-adjustment models aim to balance payments with expected healthcare costs. However, health plans can still profit significantly by strategically selecting lower-cost enrollees, especially with private information.

Area of Science:

  • Health economics
  • Healthcare policy
  • Insurance markets

Background:

  • Capitation payments in healthcare can incentivize health plans to select enrollees based on expected costs, potentially undermining equitable access.
  • Risk-adjustment models are designed to mitigate this selection bias by aligning payments with patient expenditure.
  • The effectiveness of current risk-adjustment models in preventing profitable risk selection remains a critical question in healthcare policy.

Purpose of the Study:

  • To quantify the maximum potential profit health plans could achieve through enrollment selection.
  • To evaluate the impact of different risk-adjustment models on potential selection profits.
  • To assess the role of private information in enabling profitable risk selection.

Main Methods:

Related Experiment Videos

  • Simulations were conducted using a privately insured sample dataset.
  • Four common risk-adjustment models were analyzed.
  • The study modeled hypothetical gains from selecting low-cost enrollees based on private information.

    • Main Results:

    • Risk selection profits were found to be substantial even with risk-adjustment models in place.
    • The magnitude of potential profits varied significantly across the analyzed risk-adjustment models.
    • The availability and type of private information influenced the profitability of risk selection.

    Conclusions:

    • Current risk-adjustment models may not fully eliminate the potential for profitable risk selection by health plans.
    • Health plans may still exploit information advantages to gain profits through selective enrollment.
    • Further refinements to risk-adjustment models and oversight are likely needed to ensure equitable insurance markets.