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Beyond Statistics: The Economic Content of Risk Scores

Author

Listed:
  • Liran Einav

    (Stanford University and NBER)

  • Amy Finkelstein

    (Massachusetts Institute of Technology and NBER)

  • Raymond Kluender

    (Massachusetts Institute of Technology and NBER)

  • Paul Schrimpf

    (University of British Columbia)

Abstract

In recent years, the increased use of "big data" and statistical techniques to score potential transactions has transformed the operation of insurance and credit markets. In this paper, we observe that these widely-used scores are statistical objects that constitute a one-dimensional summary of a potentially much richer heterogeneity, some of which may be endogenous to the specific context in which they are applied. We demonstrate this point empirically using rich data from the Medicare Part D prescription drug insurance program. We show that the "risk scores", which are designed to predict an individual's drug spending and are used by Medicare to customize reimbursement rates to private insurers, do not distinguish between two different sources of spending: underlying health, and responsiveness of drug spending to the insurance contract. Naturally, however, these two determinants of spending have very different implications when trying to predict counterfactual spending under alternative contracts. As a result, we illustrate that once we enrich the theoretical framework to allow individuals to have heterogeneous behavioral responses to the contract, strategic incentives for cream skimming still exist, even in the presence of "perfect" risk scoring under a given contract.

Suggested Citation

  • Liran Einav & Amy Finkelstein & Raymond Kluender & Paul Schrimpf, "undated". "Beyond Statistics: The Economic Content of Risk Scores," Discussion Papers 15-024, Stanford Institute for Economic Policy Research.
  • Handle: RePEc:sip:dpaper:15-024
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    2. Delphine Roy, 2025. "Strategic Coding in the Assessment of Long‐Term Care Needs: Evidence From France," Health Economics, John Wiley & Sons, Ltd., vol. 34(6), pages 1035-1063, June.
    3. Michele Fioretti & Hongming Wang, 2023. "Performance Pay in Insurance Markets: Evidence from Medicare," The Review of Economics and Statistics, MIT Press, vol. 105(5), pages 1128-1144, September.
    4. Zwart, Gijsbert, 2025. "Moral hazard and risk adjustment," Journal of Health Economics, Elsevier, vol. 99(C).
    5. Martin Eling & Irina Gemmo & Danjela Guxha & Hato Schmeiser, 2024. "Big data, risk classification, and privacy in insurance markets," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 49(1), pages 75-126, March.
    6. Mark Shepard, 2016. "Hospital Network Competition and Adverse Selection: Evidence from the Massachusetts Health Insurance Exchange," NBER Working Papers 22600, National Bureau of Economic Research, Inc.
    7. Carey, Colleen, 2021. "Sharing the burden of subsidization: Evidence on pass-through from a subsidy revision in Medicare Part D," Journal of Public Economics, Elsevier, vol. 198(C).
    8. Moiz Bhai & Danny Hughes, 2024. "Estimating Self-Selection in Medicare Advantage," Working Papers 2024-009, Human Capital and Economic Opportunity Working Group.
    9. Michael Geruso & Timothy Layton, 2020. "Upcoding: Evidence from Medicare on Squishy Risk Adjustment," Journal of Political Economy, University of Chicago Press, vol. 128(3), pages 984-1026.
    10. Sriubaite, I. & Harris, A. & Jones, A.M. & Gabbe, B., 2020. "Economic Consequences of Road Traffic Injuries. Application of the Super Learner algorithm," Health, Econometrics and Data Group (HEDG) Working Papers 20/20, HEDG, c/o Department of Economics, University of York.
    11. Daniel Montanera & Abhay Nath Mishra & T. S. Raghu, 2022. "Mitigating Risk Selection in Healthcare Entitlement Programs: A Beneficiary-Level Competitive Bidding Approach," Information Systems Research, INFORMS, vol. 33(4), pages 1221-1247, December.
    12. Sungchul Park & Anirban Basu, 2018. "Alternative evaluation metrics for risk adjustment methods," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 984-1010, June.
    13. De Giorgi, Giacomo & Drenik, Andres & Seira Bejarano, Enrique, 2017. "Sequential Banking: Direct and Externality Effects on Delinquency," CEPR Discussion Papers 12280, C.E.P.R. Discussion Papers.

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    Keywords

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    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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