探討台灣風險計價模式之選擇與效率誘因及其最適化之分析
Date Issued
2003-07-31
Date
2003-07-31
Author(s)
DOI
912416H002038
Abstract
This study intends to evaluate the
impacts of various risk sharing forms on
the selection and efficiency incentives of
health plans in a competitive health
insurance market. Different risk-adjusted
models employed by the equalization
fund and health plans are to be analyzed
to understand the robustness of these risk
share forms.
A total of 371,620 beneficiaries,
eligible for the National Health Insurance
(NHI) from January 1, 1996 to January 1,
1997 were randomly selected from the
enrollment file of NHI. The risk-adjusted
models employed by the equalization
fund were the demographic and
diagnostic-based models. On the other
hand, health plans employed the prior
utilization, diagnostic-based, and all
information models. Risk sharing forms
analyzed were 1% to 5% high-risk
sharing, 1% to 5% high-cost sharing,
60,000 NT$ to 100,000NT$ excess loss,
2
and 30% to 70% partial capitation. The
measures of the selection incentive were
mean absolute predicted result and
unfavorable expected loss. The measures
of the efficiency incentive were the
proportion shared expenditures by a risk
sharing mechanism and insurer portion of
the efficiency gain.
The results showed that among four
risk sharing forms high-risk sharing could
provide better efficiency incentive than
the others. On the other hand, high-cost
sharing could contain selection incentive
better than the others. In order to
maintain both the incentives, large
percentage of high-risk sharing and small
percentage of high-cost sharing would be
appropriate choices.
Subjects
health insurance
risk adjustment
risk sharing
risk selection
Publisher
臺北市：國立臺灣大學公共衛生學院醫療機構管理研究所
Type
report
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