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Author: Rudy C. Douven
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages : 52
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Book Description
Author: Rudy C. Douven
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages : 52
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Book Description
Author: Thomas G. McGuire
Publisher: Academic Press
ISBN: 012811326X
Category : Business & Economics
Languages : en
Pages : 659
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Book Description
Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness
Author: Thomas G. McGuire
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Reinsurance can complement risk adjustment of health plan payments to improve fit of payments to plan spending at the individual and group level. This paper proposes three improvements in health plan payment systems using reinsurance. First, we base reinsurance payments on spending not accounted for by the risk adjustment system, rather than just high spending. Second, we propose pairing reinsurance for individual-level losses with repayments for individual-level profits. Third, we optimize the weights on the risk adjustors taking account of the presence of reinsurance/repayment. We implement our methodology in data from Germany, The Netherlands and the U.S. Marketplaces, comparing our modified approach to plan payment with risk adjustment as currently practiced in the three settings. The combination of the three improvements yields very substantial improvements in the individual-level fit of payments to plan spending in all three countries.
Author: Adam J. Oliver
Publisher:
ISBN: 9781899040216
Category : Health insurance
Languages : en
Pages : 67
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Book Description
Author:
Publisher:
ISBN:
Category : Health care reform
Languages : en
Pages : 254
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Book Description
Author: Rudy C. Douven
Publisher:
ISBN:
Category : Competition
Languages : en
Pages : 56
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Book Description
Author: World Health Organization
Publisher:
ISBN: 9789289050302
Category : Medical
Languages : en
Pages : 0
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Book Description
This publication explores some of the key issues, ranging from interpreting the evidence base to assessing the policy context for, and approaches to, chronic disease management across Europe. Drawing on 12 detailed country reports (available in a second, online volume), the study provides insights into the range of care models and the people involved in delivering these; payment mechanisms and service user access; and challenges faced by countries in the implementation and evaluation of these novel approaches.
Author: Ian G. Duncan
Publisher: ACTEX Publications
ISBN: 1566987695
Category : Business & Economics
Languages : en
Pages : 350
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Book Description
This text is listed on the Course of Reading for SOA Fellowship study in the Group & Health specialty track. Healthcare Risk Adjustment and Predictive Modeling provides a comprehensive guide to healthcare actuaries and other professionals interested in healthcare data analytics, risk adjustment and predictive modeling. The book first introduces the topic with discussions of health risk, available data, clinical identification algorithms for diagnostic grouping and the use of grouper models. The second part of the book presents the concept of data mining and some of the common approaches used by modelers. The third and final section covers a number of predictive modeling and risk adjustment case-studies, with examples from Medicaid, Medicare, disability, depression diagnosis and provider reimbursement, as well as the use of predictive modeling and risk adjustment outside the U.S. For readers who wish to experiment with their own models, the book also provides access to a test dataset.
Author: Who Regional Office for Europe
Publisher: World Health Organization
ISBN: 9289051701
Category : Medical
Languages : en
Pages : 148
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Book Description
What are public health services? Countries across Europe understand what they are or what they should include differently. This study describes the experiences of nine countries detailing the ways they have opted to organize and finance public health services and train and employ their public health workforce. It covers England France Germany Italy the Netherlands Slovenia Sweden Poland and the Republic of Moldova and aims to give insights into current practice that will support decision-makers in their efforts to strengthen public health capacities and services. Each country chapter captures the historical background of public health services and the context in which they operate; sets out the main organizational structures; assesses the sources of public health financing and how it is allocated; explains the training and employment of the public health workforce; and analyses existing frameworks for quality and performance assessment. The study reveals a wide range of experience and variation across Europe and clearly illustrates two fundamentally different approaches to public health services: integration with curative health services (as in Slovenia or Sweden) or organization and provision through a separate parallel structure (Republic of Moldova). The case studies explore the context that explain this divergence and its implications. This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe Division of Health Systems and Public Health. It accompanies two other Observatory publications Organization and financing of public health services in Europe and The role of public health organizations in addressing public health problems in Europe: the case of obesity alcohol and antimicrobial resistance (both forthcoming).
Author: Vincent A. W. J. Marchau
Publisher: Springer
ISBN: 3030052524
Category : Business & Economics
Languages : en
Pages : 408
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Book Description
This open access book focuses on both the theory and practice associated with the tools and approaches for decisionmaking in the face of deep uncertainty. It explores approaches and tools supporting the design of strategic plans under deep uncertainty, and their testing in the real world, including barriers and enablers for their use in practice. The book broadens traditional approaches and tools to include the analysis of actors and networks related to the problem at hand. It also shows how lessons learned in the application process can be used to improve the approaches and tools used in the design process. The book offers guidance in identifying and applying appropriate approaches and tools to design plans, as well as advice on implementing these plans in the real world. For decisionmakers and practitioners, the book includes realistic examples and practical guidelines that should help them understand what decisionmaking under deep uncertainty is and how it may be of assistance to them. Decision Making under Deep Uncertainty: From Theory to Practice is divided into four parts. Part I presents five approaches for designing strategic plans under deep uncertainty: Robust Decision Making, Dynamic Adaptive Planning, Dynamic Adaptive Policy Pathways, Info-Gap Decision Theory, and Engineering Options Analysis. Each approach is worked out in terms of its theoretical foundations, methodological steps to follow when using the approach, latest methodological insights, and challenges for improvement. In Part II, applications of each of these approaches are presented. Based on recent case studies, the practical implications of applying each approach are discussed in depth. Part III focuses on using the approaches and tools in real-world contexts, based on insights from real-world cases. Part IV contains conclusions and a synthesis of the lessons that can be drawn for designing, applying, and implementing strategic plans under deep uncertainty, as well as recommendations for future work. The publication of this book has been funded by the Radboud University, the RAND Corporation, Delft University of Technology, and Deltares.
