Outpatient encounter data for risk adjustment--a view from Europe: comments on Welch

This article comments from a European perspective on W. Pete Welch's article, which examines the use of outpatient encounter data for risk adjustment. Although diverse, Western European health care systems all seek to provide a comprehensive package of care, financed by premiums unrelated to health status. Some form of risk adjustment is therefore required as a basis for funding insurers in all systems. Two objectives have dominated: to secure equity between patients covered by different insurers and to ensure that (where implemented) competitive insurer markets operate efficiently. The commentary concludes that, although risk adjustment research of this type is important, the most fundamental requirement is to develop a more active purchasing function on the part of insurers.