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Measuring Adverse Selection in Managed Health Care

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Author Info
Richard G. Frank
Jacob Glazer
Thomas G. McGuire
Abstract

Health plans paid by capitation have an incentive to distort the quality of services they offer to attract profitable and to deter unprofitable enrollees. We characterize plans' rationing as imposing a show that the profit maximizing shadow price depends on the dispersion in health costs, how well individuals forecast their health costs, the correlation between use in different illness categories, and the risk adjustment system used for payment. We further show how these factors can be combined in an empirically implementable index that can be used to identify the services that will be most distorted in competition among managed care plans. A simple welfare measure is developed to quantify the distortion caused by selection incentives. We illustrate the application of our ideas with a Medicaid data set, and conduct policy analyses of risk adjustment and other options for dealing with adverse selection.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 6825.

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Date of creation: Dec 1998
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Handle: RePEc:nbr:nberwo:6825

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Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. David M. Cutler & Richard J. Zeckhauser, 1997. "Adverse Selection in Health Insurance," NBER Working Papers 6107, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  2. Rothschild, Michael & Stiglitz, Joseph E, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, MIT Press, vol. 90(4), pages 630-49, November.
  3. Mullahy, John, 1998. "Much ado about two: reconsidering retransformation and the two-part model in health econometrics," Journal of Health Economics, Elsevier, vol. 17(3), pages 247-281, June. [Downloadable!] (restricted)
  4. Dranove, David & White, William D, 1994. "Recent Theory and Evidence on Competition in Hospital Markets," Journal of Economics & Management Strategy, Blackwell Publishing, vol. 3(1), pages 169-209, Spring.
  5. Cutler, David M, 1994. "A Guide to Health Care Reform," Journal of Economic Perspectives, American Economic Association, vol. 8(3), pages 13-29, Summer. [Downloadable!] (restricted)
  6. Rogerson, William P, 1994. "Choice of Treatment Intensities by a Nonprofit Hospital under Prospective Pricing," Journal of Economics & Management Strategy, Blackwell Publishing, vol. 3(1), pages 7-51, Spring.
  7. Hendricks, K. & Piccione, M. & Tan, G., 1995. "Entry and Exit in Hub-Spoke Networks," UBC Departmental Archives 95-20, UBC Department of Economics.
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  8. Ma, Ching-to Albert & McGuire, Thomas G, 1997. "Optimal Health Insurance and Provider Payment," American Economic Review, American Economic Association, vol. 87(4), pages 685-704, September. [Downloadable!] (restricted)
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  9. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October. [Downloadable!] (restricted)
  10. Sherry Glied & Jane Sisk & Sheila Gorman & Michael Ganz, 1997. "Selection, Marketing, and Medicaid Managed Care," NBER Working Papers 6164, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Yuriy Pylypchuk & Julie Hudson, 2009. "Immigrants and the use of preventive care in the United States," Health Economics, John Wiley & Sons, Ltd., vol. 18(7), pages 783-806. [Downloadable!]
  2. Rhema Vaithianathan, 2001. "An Economic Analysis of the Private Health Insurance Incentive Act (1998)," CEPR Discussion Papers 427, Centre for Economic Policy Research, Research School of Social Sciences, Australian National University. [Downloadable!]
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