Provider payment mechanisms were adjusted in many countries in response to the COVID-
19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare …

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 …

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland
have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible …

Risk adjustment for health plan payment is a bundled payment strategy in which payments
are based on mathematical formulas that predict health plan obligations for spending on …

Background: Hospital professionals are" dual agents" who may face dilemmas between their
commitment to patients' clinical needs and hospitals' financial sustainability. This study …

In many markets, including the new US Marketplaces, health insurance plans are paid by
risk-adjusted capitation, sometimes combined with reinsurance and other payment …

Adverse selection in health insurance markets leads to two types of inefficiency. On the
demand side, adverse selection leads to plan price distortions resulting in inefficient sorting …

The Netherlands relies on risk equalization to compensate competing health insurers for
predictable variation in individual medical expenses. Without accurate risk equalization …

Risk-adjustment is critical to the functioning of regulated health insurance markets. To date,
estimation and evaluation of a risk-adjustment model has been based on statistical rather …

Reinsurance can complement risk adjustment of health plan payments to improve fit of
payments to plan spending at the individual and group level. This paper proposes three …