Risk adjustment, risk sharing and premium regulation in health insurance markets : theory and practice

Front Cover -- Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets -- Copyright Page -- Contents -- List of Contributors -- Regulated Competition in Health Insurance Markets: Foreword by Alain Enthoven -- Acknowledgments -- I: Theory -- 1 Regulated Competition in Health Insurance Markets: Paradigms and Ongoing Issues -- 1.1 Introduction -- 1.2 Intellectual Roots of Regulated Competition -- 1.2.1 Evolution of the Enthoven Model: Individual-Insurance Markets Managed by a Sponsor-Regulator -- 1.2.2 Diamond Model: "First-Stage" Group-Level Competition -- 1.3 Prevalence of Regulated Competition -- 1.3.1 Individual and Group-Level Competition in the United States -- 1.3.2 Individual-Level Competition in Europe -- 1.3.3 Regulated Competition in Australia, Asia, and Latin America -- 1.4 The Role of Health Plan Payment in Regulated Competition -- 1.4.1 The Broader Menu of Regulatory Tools -- 1.4.2 Regulation of Health Plan Payment -- 1.5 The Outline of This Volume -- Endnote -- 2 Premium Regulation, Risk Equalization, Risk Sharing, and Subsidies: Effects on Affordability and Efficiency -- 2.1 Introduction -- 2.1.1 Risk Rating: A Threat to the Affordability of Basic Coverage for High-Risk People -- 2.1.2 Risk Selection: A Threat to Both Affordability and Efficiency -- 2.1.3 The Goal and Outline of This Chapter -- 2.2 Starting Point of Our Analyses -- 2.3 How Risk Rating and Risk Selection Affect Efficiency: A Graphical Framework -- 2.3.1 Risk Rating: Good for Efficiency -- 2.3.2 Risk Selection by Consumers: Bad for Efficient Sorting -- 2.3.3 Risk Selection by Insurers: Bad for Efficiency of Plan Design and Efficiency of Production -- 2.4 Benchmark for Analyzing the Effects of Payment System Interventions -- 2.5 Premium Regulation -- 2.6 Risk Equalization, Risk Sharing, and Subsidies to Insurers.