Potential methods to reduce risk selection and its effects

Article Abstract:

Effective risk assessment and risk adjustment methods are critical to the successful implementation of health care reforms. Such methods can reduce the negative effects of risk selection by taking into account the different factors that give rise to differences in health risk among individuals. These include socioeconomic and environmental factors and the variability in their genetic susceptibility to illness. If these factors are ignored, the efficiency of managed health care will suffer due to the insurers' preference toward low-risk customers.

Accident & Health Insurance, Insurance Carriers, Direct Health and Medical Insurance Carriers, Preferred Provider Health Plans, Social aspects, Risk assessment, Health care industry, Health insurance, Insurance claims adjustment, Preferred provider organizations (Medical care)

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Assessing risk-adjustment approaches under non-random selection

Article Abstract:

Different methods and policies are projected to reduce difficulty in adjusting differences in enrollee risk in health plans. Simulation is found out to be the best method of the lot.

Medicare

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The failed conversion of CareFirst BlueCross BlueShield to for-profit status: part 2, lessons learned

Article Abstract:

A case study on CareFirst BlueCross BlueShield, which examines the viability of proposals of nonprofit health care organizations to convert to for-profit status, is presented.

Voluntary health agencies

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