| 来源类型 | Working Paper |
| 规范类型 | 报告 |
| DOI | 10.3386/w23765 |
| 来源ID | Working Paper 23765 |
| The Impact of Partial-Year Enrollment on the Accuracy of Risk Adjustment Systems: A Framework and Evidence | |
| Keith Marzilli Ericson; Kimberley Geissler; Benjamin Lubin | |
| 发表日期 | 2017-09-11 |
| 出版年 | 2017 |
| 语种 | 英语 |
| 摘要 | Accurate risk adjustment facilitates healthcare market competition. Risk adjustment typically aims to predict annual costs of individuals enrolled in an insurance plan for a full year. However, partial-year enrollment is common and poses a challenge to risk adjustment, since diagnoses are observed with lower probability when individual is observed for a shorter time. Due to missed diagnoses, risk adjustment systems will underpay for partial-year enrollees, as compared to full-year enrollees with similar underlying health status and usage patterns. We derive a new adjustment for partial-year enrollment in which payments are scaled up for partial-year enrollees’ observed diagnoses, which improves upon existing methods. We simulate the role of missed diagnoses using a sample of commercially insured individuals and the 2014 Marketplace risk adjustment algorithm, and find the expected spending of six-month enrollees is underpredicted by 19%. We then examine whether there are systematically different care usage patterns for partial-year enrollees in this data, which can offset or amplify underprediction due to missed diagnoses. Accounting for differential spending patterns of partial-year enrollees does not substantially change the underprediction for six-month enrollees. However, one-month enrollees use systematically less than one-twelfth the care of full-year enrollees, partially offsetting the missed diagnosis effect. |
| 主题 | Health, Education, and Welfare ; Health |
| URL | https://www.nber.org/papers/w23765 |
| 来源智库 | National Bureau of Economic Research (United States) |
| 引用统计 | |
| 资源类型 | 智库出版物 |
| 条目标识符 | http://119.78.100.153/handle/2XGU8XDN/581439 |
| 推荐引用方式 GB/T 7714 | Keith Marzilli Ericson,Kimberley Geissler,Benjamin Lubin. The Impact of Partial-Year Enrollment on the Accuracy of Risk Adjustment Systems: A Framework and Evidence. 2017. |
| 条目包含的文件 | ||||||
| 文件名称/大小 | 资源类型 | 版本类型 | 开放类型 | 使用许可 | ||
| w23765.pdf（903KB） | 智库出版物 | 限制开放 | CC BY-NC-SA | 浏览 | ||
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