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Risk adjustment in aging societies.

Viktor von Wyl1, Konstantin Beck

  • 1CSS-Institute for Empirical Health Economics, Tribschenstrasse 21, 6002, Luzern, Switzerland, viktor.vonwyl@css-institut.ch.

Health Economics Review
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Summary
This summary is machine-generated.

Young adults in Switzerland face rising health insurance costs due to age-related risk adjustment (RA) transfers. While lifetime RA transfers remain positive, capping payments could protect vulnerable groups from increasing burdens.

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Area of Science:

  • Health Economics
  • Demographic Analysis
  • Social Insurance Policy

Background:

  • Switzerland's age-based risk adjustment (RA) system places increasing financial burdens on young adults.
  • Demographic shifts, including an aging population, exacerbate cost-sharing imbalances in health insurance.
  • Monthly solidarity payments for young adults (19-25) doubled between 1996 and 2011.

Purpose of the Study:

  • To investigate the causes and consequences of demographic changes on RA payments.
  • To model age-specific RA growth and lifetime RA transfer sums.
  • To propose methods for controlling intergenerational fund redistribution in health financing.

Main Methods:

  • Developed mathematical models for age-specific risk adjustment (RA) growth.
  • Calculated the lifetime sum of RA transfers.
  • Analyzed the impact of healthcare expenditure (HCE) growth rates and demographic shifts on RA payments.

Main Results:

  • Below-average healthcare expenditure (HCE) growth in young adults (2%/year) compared to older adults (4%/year) was the primary driver of RA increases.
  • Demographic shifts accounted for only 2% of the rise in RA payments.
  • Lifetime RA transfers remain positive if HCE growth exceeds the 3% discount rate; demographic changes may increase lifetime returns.

Conclusions:

  • Mathematical modeling provides insights into demographic impacts on RA and intergenerational fund redistribution.
  • Methods to control redistribution can be implemented without creating adverse selection incentives.
  • Equitable health financing systems can be developed to address population aging and its financial implications.