Explanipedia

Does Health-Based Prospective Risk Adjustment Adequately Compensate for Individuals Diagnosed With a New Chronic Disease? Open

Michel Oskam, Richard C. van Kleef, René C.J.A. van Vliet · 2025

Many regulated health insurance markets use prospective risk adjustment (RA) to mitigate risk selection incentives for insurers. However, prospective RA might underpay insurers for people diagnosed with a new chronic disease. By tracking s…

Supplementing risk adjustment with high‐risk pooling using historical data for identifying the high risks Open

Michel Oskam, Richard C. van Kleef, René C.J.A. van Vliet · 2024

Many regulated health insurance markets with community‐rated premiums rely on risk adjustment (RA) to mitigate insurer‐incentives to risk select. However, insurers remain typically undercompensated for chronically ill enrollees. We use his…

A Framework for the Design of Risk-Adjustment Models in Health care Provider Payment Systems Open

Andreea Panturu, Richard C. van Kleef, Frank Eijkenaar, Daniëlle Cattel · 2024

Prospective payments for health care providers require adequate risk adjustment (RA) to address systematic variation in patients’ health care needs. However, the design of RA for provider payment involves many choices and difficult trade-o…

A critical review of the use of R2 in risk equalization research Open

Wynand van de Ven, Richard C. van Kleef · 2024

Nearly all empirical studies that estimate the coefficients of a risk equalization formula present the value of the statistical measure R 2 . The R 2 -value is often (implicitly) interpreted as a measure of the extent to which the risk equ…

A framework for ex-ante evaluation of the potential effects of risk equalization and risk sharing in health insurance markets with regulated competition Open

Richard C. van Kleef, Mieke Reuser, P. Stam, Wynand P.M.M. van de Ven · 2024

High-risk pooling for mitigating risk selection incentives in health insurance markets with sophisticated risk equalization: an application based on health survey information Open

A. A. Withagen-Koster, Richard C. van Kleef, Frank Eijkenaar · 2024

Background Despite sophisticated risk equalization, insurers in regulated health insurance markets still face incentives to attract healthy people and avoid the chronically ill because of predictable differences in profitability between th…

Scope and Incentives for Risk Selection in Health Insurance Markets With Regulated Competition: A Conceptual Framework and International Comparison Open

Richard C. van Kleef, Mieke Reuser, Thomas G. McGuire, John Armstrong, Konstantin Beck , et al. · 2024

In health insurance markets with regulated competition, regulators face the challenge of preventing risk selection. This paper provides a framework for analyzing the scope (i.e., potential actions by insurers and consumers) and incentives …

Risk Adjustment in Health Insurance Markets Open

Richard C. van Kleef, René C.J.A. van Vliet, Michel Oskam · 2023

Objectives: The goals of this paper are: (1) to identify groups of healthy people; and (2) to quantify the extent to which the Dutch risk adjustment (RA) model overpays insurers for these groups. Background: There have been strong signals …

Heteroscedasticity of residual spending after risk equalization: a potential source of selection incentives in health insurance markets with premium regulation Open

Michel Oskam, Richard C. van Kleef, Rudy Douven · 2023

Many community-rated health insurance markets include risk equalization (also known as risk adjustment) to mitigate risk selection incentives for competing insurers. Empirical evaluations of risk equalization typically quantify selection i…

Predictable profits and losses in a health insurance market with risk equalization: A multiple-contract period perspective Open

A. A. Withagen-Koster, Richard C. van Kleef, Frank Eijkenaar · 2023

Improving diagnosis-based cost groups in the Dutch risk equalization model: the effects of a new clustering method and allowing for multimorbidity Open

Michel Oskam, Richard C. van Kleef, René C.J.A. van Vliet · 2023

Health insurance markets with community-rated premiums typically use risk equalization (RE) to compensate insurers for predictable profits on people in good health and predictable losses on those with a chronic disease. Over the past decad…

Selection Incentives in the Dutch Basic Health Insurance: To What Extent Does End-of-Life Spending Contribute to Predictable Profits and Losses for Selective Groups? Open

A. A. Withagen-Koster, Richard C. van Kleef, Frank Eijkenaar · 2022

Existing risk-equalization models in individual health insurance markets with premium-rate restrictions do not completely compensate insurers for predictable profits/losses, confronting insurers with risk selection incentives. To guide fur…

How to deal with persistently low/high spenders in health plan payment systems? Open

Richard C. van Kleef, René C.J.A. van Vliet · 2022

Health insurance markets with community‐rated premiums typically include risk adjustment (RA) to mitigate selection problems. Over the past decades, RA systems have evolved from simple demographic models to sophisticated morbidity‐based mo…

Can risk rating increase the ability of voluntary deductibles to reduce moral hazard? Open

Marcello Antonini, Richard C. van Kleef, Josefa Henríquez, Francesco Paolucci · 2021

How the COVID-19 pandemic can distort risk adjustment of health plan payment Open

Richard C. van Kleef, Mieke Reuser · 2021

The COVID-19 pandemic has led to disruptions in healthcare utilization and spending. While some changes might persist (e.g. substitution of specialist visits by online consultations), others will be transitory (e.g. fewer surgical procedur…

Very high and low residual spenders in private health insurance markets: Germany, The Netherlands and the U.S. Marketplaces Open

Thomas G. McGuire, Sonja Schillo, Richard C. van Kleef · 2020

Exploiting Incomplete Information in Risk Adjustment Using Constrained Regression Open

Richard C. van Kleef, Frank Eijkenaar, René C.J.A. van Vliet, M. Nielen · 2020

Background\nHealth insurance markets with regulated premiums typically include risk adjustment (RA) to mitigate selection incentives. Even the most sophisticated RA models, however, tend to undercompensate (overcompensate) insurers for peo…

Paying for Mental Health Care in Private Health Insurance in the Netherlands: Some Lessons for the United States Open

Thomas G. McGuire, Richard C. van Kleef, Suzanne H. C. M. van Veen · 2020

Incorporating self-reported health measures in risk equalization through constrained regression Open

A. A. Withagen-Koster, Richard C. van Kleef, Frank Eijkenaar · 2020

Selection Incentives for Health Insurers in the Presence of Sophisticated Risk Adjustment Open

Richard C. van Kleef, Frank Eijkenaar, René C.J.A. van Vliet · 2019

This article analyzes selection incentives for insurers in the Dutch basic health insurance market, which operates with community-rated premiums and sophisticated risk adjustment. Selection incentives result from the interplay of three mar…

Risk equalization in competitive health insurance markets: Identifying healthy individuals on the basis of multiple‐year low spending Open

Frank Eijkenaar, René C.J.A. van Vliet, Richard C. van Kleef · 2018

Objective To study the extent to which risk equalization (RE) in competitive health insurance markets can be improved by including an indicator for being healthy. Study Setting/Data Sources This study is conducted in the context of the Dut…

Deriving risk adjustment payment weights to maximize efficiency of health insurance markets Open

Timothy Layton, Thomas G. McGuire, Richard C. van Kleef · 2018

Examining unpriced risk heterogeneity in the Dutch health insurance market Open

A. A. Withagen-Koster, Richard C. van Kleef, Frank Eijkenaar · 2018

A major challenge in regulated health insurance markets is to mitigate risk selection potential. Risk selection can occur in the presence of unpriced risk heterogeneity, which refers to predictable variation in health care spending not ref…

Deriving risk adjustment payment weights to maximize efficiency of health insurance markets Open

Timothy Layton, Thomas G. McGuire, Richard C. van Kleef · 2018

Risk adjustment of payments to health plans is fundamental to regulated competition among private insurers, which serves as the basis of national health policy in many countries. To date, estimation and evaluation of a risk adjustment mode…

Introduction to the special section health plan payment in regulated competition Open

Thomas G. McGuire, Richard C. van Kleef · 2017

Can premium differentiation counteract adverse selection in the Dutch supplementary health insurance? A simulation study Open

K. P. M. van Winssen, Richard C. van Kleef, Wynand P.M.M. van de Ven · 2017

Exploring the predictive power of interaction terms in a sophisticated risk equalization model using regression trees Open

S. H. C. M. van Veen, Richard C. van Kleef, Wynand P.M.M. van de Ven, René C.J.A. van Vliet · 2017

This study explores the predictive power of interaction terms between the risk adjusters in the Dutch risk equalization (RE) model of 2014. Due to the sophistication of this RE‐model and the complexity of the associations in the dataset (N…

Improving risk equalization with constrained regression Open

Richard C. van Kleef, Thomas G. McGuire, René C.J.A. van Vliet, Wynand P. P. M. van de Ven · 2016

A method to simulate incentives for cost containment under various cost sharing designs: an application to a first-euro deductible and a doughnut hole Open

Daniëlle Cattel, Richard C. van Kleef, René C.J.A. van Vliet · 2016

The demand for health insurance and behavioural economics Open

K. P. M. van Winssen, Richard C. van Kleef, Wynand P.M.M. van de Ven · 2016

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