IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v8y1999i6p547-552.html
   My bibliography  Save this article

Inferring capitation rates from aggregate health plans’ costs

Author

Listed:
  • Amir Shmueli

Abstract

Setting risk‐adjusted capitation rates in health systems with centralized financing and decentralized delivery is one of the most intriguing policy issues. The common practice to set capitation group rates is based on individual data collected from either population surveys or medical records, using a single—and in most cases arbitrary—set of relative unit costs of services. This paper presents a method for estimating group‐specific mean costs and capitation rates using a panel of aggregate cost data of the competing health plans and the composition of their populations. This method is used to estimate mean costs and capitation rates for the Israeli health care system. The limited data available severely constrains the range of estimable models, however, the results evoke some questions with regards to reimbursement and rates presently used, as well as to the methodology used to estimate them. Copyright © 1999 John Wiley & Sons, Ltd.

Suggested Citation

  • Amir Shmueli, 1999. "Inferring capitation rates from aggregate health plans’ costs," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 547-552, September.
    • Handle: RePEc:wly:hlthec:v:8:y:1999:i:6:p:547-552
    DOI: 10.1002/(SICI)1099-1050(199909)8:6<547::AID-HEC463>3.0.CO;2-U
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/(SICI)1099-1050(199909)8:63.0.CO;2-U
    Download Restriction: no
    File URL: https://libkey.io/10.1002/(SICI)1099-1050(199909)8:6<547::AID-HEC463>3.0.CO;2-U?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Erik Schokkaert & Geert Dhaene & Carine Van De Voorde, 1998. "Risk adjustment and the trade‐off between efficiency and risk selection: an application of the theory of fair compensation," Health Economics, John Wiley & Sons, Ltd., vol. 7(5), pages 465-480, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Oliveira, Monica Duarte & Bevan, Gwyn, 2003. "Measuring geographic inequities in the Portuguese health care system: an estimation of hospital care needs," Health Policy, Elsevier, vol. 66(3), pages 277-293, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    2. Z. F. Ibragimova & M. V. Frants, 2022. "Inequality of Opportunity: Unobserved Factors in Empirical Research," Studies on Russian Economic Development, Springer, vol. 33(3), pages 328-335, June.
    3. Schokkaert, Erik & Van de Voorde, Carine, 2003. "Belgium: risk adjustment and financial responsibility in a centralised system," Health Policy, Elsevier, vol. 65(1), pages 5-19, July.
    4. van de Ven, Wynand P. M. M. & van Vliet, Rene C. J. A. & Schut, Frederik T. & van Barneveld, Erik M., 2000. "Access to coverage for high-risks in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted premium subsidies?," Journal of Health Economics, Elsevier, vol. 19(3), pages 311-339, May.
    5. Wynand P. M. M. Ven & René C. J. A. Vliet & Richard C. Kleef, 2017. "How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(2), pages 167-180, March.
    6. Schut, Frederik T. & van Doorslaer, Eddy K. A., 1999. "Towards a reinforced agency role of health insurers in Belgium and the Netherlands," Health Policy, Elsevier, vol. 48(1), pages 47-67, July.
    7. Michiel Bijlsma & Jan Boone & Gijsbert Zwart, 2014. "Competition leverage: how the demand side affects optimal risk adjustment," RAND Journal of Economics, RAND Corporation, vol. 45(4), pages 792-815, December.
    8. François Maniquet, 2004. "On the equivalence between welfarism and equality of opportunity," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 23(1), pages 127-147, August.
    9. Sato, Azusa, 2012. "Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?," World Development, Elsevier, vol. 40(11), pages 2275-2289.
    10. Dhaene, Geert & Schokkaert, Erik & Van de Voorde, Carine, 2003. "Best affine unbiased response decomposition," Journal of Multivariate Analysis, Elsevier, vol. 86(2), pages 242-253, August.
    11. X. Ramos & D. Van De Gaer, 2012. "Empirical Approaches to Inequality of Opportunity: Principles, Measures, and Evidence," Working Papers of Faculty of Economics and Business Administration, Ghent University, Belgium 12/792, Ghent University, Faculty of Economics and Business Administration.
    12. Erik Schokkaert & Kurt Devooght, 2003. "Responsibility-sensitive fair compensation in different cultures," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 21(2), pages 207-242, October.
    13. Karen Eggleston & Randall P. Ellis & Mingshan Lu, 2007. "Prevention and Dynamic Risk Adjustment," Boston University - Department of Economics - Working Papers Series WP2007-023, Boston University - Department of Economics.
    14. Marta González-Touya & Alexandrina Stoyanova & Rosa M. Urbanos-Garrido, 2021. "COVID-19 and Unmet Healthcare Needs of Older People: Did Inequity Arise in Europe?," IJERPH, MDPI, vol. 18(17), pages 1-15, August.
    15. Susanna Kochskämper, 2012. "Reformdebatten in der Krankenversicherung vor dem Hintergrund des europäischen Binnenmarktes," Otto-Wolff-Institut Discussion Paper Series 02/2012, Otto-Wolff-Institut für Wirtschaftsordnung, Köln, Deutschland.
    16. repec:clg:wpaper:2007-06 is not listed on IDEAS
    17. Christine Arentz & Johann Eekhoff & Susanna Kochskämper, 2012. "Private health insurance: a role model for European health systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 615-621, October.
    18. Xavier Ramos & Dirk Van de gaer, 2012. "Empirical approaches to inequality of opportunity: Principles, measures, and evidence," Working Papers 259, ECINEQ, Society for the Study of Economic Inequality.
    19. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    20. Schokkaert, Erik & Van de Voorde, Carine, 2004. "Risk selection and the specification of the conventional risk adjustment formula," Journal of Health Economics, Elsevier, vol. 23(6), pages 1237-1259, November.
    21. Brilleman, Samuel L. & Gravelle, Hugh & Hollinghurst, Sandra & Purdy, Sarah & Salisbury, Chris & Windmeijer, Frank, 2014. "Keep it simple? Predicting primary health care costs with clinical morbidity measures," Journal of Health Economics, Elsevier, vol. 35(C), pages 109-122.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:8:y:1999:i:6:p:547-552. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.