The risk-adjustment debate

Published: December 24, 1998
Category: Papers
Author: Kuttner R
Country: United States
Language: null
Type: Care Management
Setting: Hospital

N Engl J Med 339:1952-1956.

Risk adjustment refers to the adjustment of payments to health plans (or to doctors) to reflect more accurately the actual health status or recent medical experience of patients. Risk adjustment has become an issue because payments by governments, employers, and individuals largely do not take into account differences in the health of patients among (or within) health plans. If plans receive the same unadjusted premium for each subscriber, then the plan with healthier members reaps an unearned windfall, whereas plans with sicker populations of patients face unfair losses. The problem occurs at three distinct levels.

Comment in Risk adjustment or risk avoidance? [N Engl J Med. 1998]tment or risk avoidance?Kassirer JP, Angell M. N Engl J Med. 1998 Dec 24; 339(26):

PMID: 9874620

Predictive Risk Modeling,Collective Bargaining,Fees,Medical,Hospital-Physician Joint Ventures/economics,Insurance Pools,Managed Care Programs/economics,Physicians/economics,Physicians/organization & administration,Reimbursement Mechanisms,United States

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