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Risk-adjusted capitation: recent experiences in The Netherlands
W P van de Ven1, R C van Vliet, E M van Barneveld
1Department of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
Health Affairs (Project Hope)
|January 1, 1994
Summary
Dutch health care reforms, similar to U.S. managed competition, require robust risk adjustment to prevent "cream skimming." While technically feasible, implementing effective risk-adjusted capitation payments remains a long-term challenge.
Area of Science:
- Health economics
- Health services research
- Public policy
Background:
- Market-oriented health care reforms in the Netherlands share similarities with U.S. managed competition proposals.
- Effective risk adjustment mechanisms are crucial for the success of these reforms by preventing health plans from selecting low-risk individuals ('cream skimming').
Purpose of the Study:
- To provide an overview of the Dutch health care reforms.
- To present research on risk-adjusted capitation payments within the context of these reforms.
Main Methods:
- Review of Dutch health care reforms.
- Analysis of risk adjustment mechanisms and their impact on health plan selection.
- Research into the technical feasibility of risk-adjusted capitation payments.
Main Results:
- The Dutch reforms are market-oriented and face similar challenges to U.S. managed competition models.
- Risk adjustment is identified as a critical component for preventing adverse selection and ensuring equitable competition.
- Technical solutions for risk adjustment are considered promising.
Conclusions:
- The implementation of effective risk-adjusted capitation payments in the Netherlands is a complex, long-term endeavor.
- While technical solutions show promise, practical implementation faces significant challenges.
- Continued research and policy development are necessary for successful reform outcomes.