Most competitive social health insurance markets include risk equalization to compensate insurers for predictable variation in healthcare expenses. Empirical literature shows that even the most sophisticated risk equalization models—with advanced morbidity adjusters—substantially undercompensate insurers for selected groups of high-risk individuals. In the presence of premium regulation, these undercompensations confront consumers and insurers with incentives for risk selection. An important reason for the undercompensations is that not all information with predictive value regarding healthcare expenses is appropriate for use as a morbidity adjuster. To reduce incentives for selection regarding specific groups we propose overpaying morbidity adjusters that are already included in the risk equalization model. This paper illustrates the idea of overpaying by merging data on morbidity adjusters and healthcare expenses with health survey information, and derives three preconditions for meaningful application. Given these preconditions, we think overpaying may be particularly useful for pharmacy-based cost groups.

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The European Journal of Health Economics
Erasmus School of Health Policy & Management (ESHPM)

van Kleef, R.C, van Vliet, R.C.J.A, & van de Ven, W.P.M.M. (2016). Overpaying morbidity adjusters in risk equalization models. The European Journal of Health Economics, 17(7), 885–895. doi:10.1007/s10198-015-0729-2