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Int. J. Environ. Res. Public Health 2013, 10(11), 5299-5332; doi:10.3390/ijerph10115299
Article

Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

1,*  and 2
Received: 26 August 2013; in revised form: 30 September 2013 / Accepted: 8 October 2013 / Published: 25 October 2013
(This article belongs to the Special Issue Health Market: Incentives and Competition)
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Abstract: Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems.
Keywords: risk adjustment; risk selection; health care system risk adjustment; risk selection; health care system
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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MDPI and ACS Style

Ellis, R.P.; Fernandez, J.G. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas. Int. J. Environ. Res. Public Health 2013, 10, 5299-5332.

AMA Style

Ellis RP, Fernandez JG. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas. International Journal of Environmental Research and Public Health. 2013; 10(11):5299-5332.

Chicago/Turabian Style

Ellis, Randall P.; Fernandez, Juan G. 2013. "Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas." Int. J. Environ. Res. Public Health 10, no. 11: 5299-5332.


Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert