학술논문
Risk selection in the Massachusetts State employee health insurance program.
Document Type
Journal Article
Author
Source
Subject
*Employee selection
*Medical care
*Health maintenance organizations
*Managed care programs
*Research
*Risk assessment
*State governments
*User charges
*Employer-sponsored health insurance
*Cost analysis
*Fee for service (Medical fees)
*Economics
Public health
Diagnosis related groups
Comparative studies
Discrimination in insurance
Research methodology
Medical cooperation
Evaluation research
Statistical models
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Language
ISSN
1386-9620
Abstract
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. [ABSTRACT FROM AUTHOR]