Risk selection in the Massachusetts State employee health insurance program
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2001-11-23Keywords
Costs and Cost AnalysisDiagnosis-Related Groups
Fee-for-Service Plans
Fees and Charges
Health Benefit Plans, Employee
Health Maintenance Organizations
*Insurance Selection Bias
Massachusetts
Models, Statistical
Risk Adjustment
*State Government
United States
Biostatistics
Epidemiology
Health Services Research
Insurance
Metadata
Show full item recordAbstract
Using the Diagnostic Cost Group (DCG) model developed from a national sample, we examine biased selection among one fee-for-service (FFS) plan, one preferred provider organization, and several health maintenance organizations (HMOs) in Massachusetts. The proportions of enrollees in low-risk groups are higher in the HMO plans and lower in the FFS plan. The average age in the FFS plan is 9 years greater than that in the HMO plans. Actual premiums are not consistent with risk levels among HMO plans, resulting in gains in some HMO plans and losses in others as high as 20% compared to expected expenses as computed by the DCG model.Source
Health Care Manag Sci. 2001 Dec;4(4):281-7. Link to article on publisher's site
DOI
10.1023/A:1011842327930Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47573PubMed ID
11718460Related Resources
ae974a485f413a2113503eed53cd6c53
10.1023/A:1011842327930