Optimal risk adjustment in markets with adverse selection: an application to managed care

Article Abstract:

Risk adjustment in the managed care health plan marketplace is discussed.

HEALTH SERVICES, Statistical Data Included, Managed care plans (Medical care), Health insurance industry

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Managed care, information, and diffusion: the case of treatment for heart-attack patients

Article Abstract:

The influence of health maintenance organizations and other managed care organizations on the treatment patterns provided to the patients is observed. A case where common therapies are used for heart-attack patients is considered.

Management dynamics, Care and treatment, Heart attack, Company business management, Cardiac patients

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Optimal health insurance and provider payment

Article Abstract:

An analysis of optimal health insurance administration in the absence of contractible payment methods and patient-determined input reveals that verifiable treatment reports and patient input is the best practice with truthful reporting constituting the 'second best' practice. The study also reveals that fraudulent reporting practices increase constraints that is offset by competition among physicians.

Economics, Research and Development in the Social Sciences and Humanities, Analysis, Insurance industry

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