A Model of the Impact of Reimbursement Schemes on Health Plan Choice
Published in: Journal of Health Economics, v. 17, no. 3, June 1998, p. 297-320
Posted on RAND.org on December 31, 1997
Flat capitation (uniform prospective payments) makes enrolling healthy enrollees profitable to health plans. Plans with relatively generous benefits may attract the sick and fail through a premium spiral. The authors simulate a model of idealized managed competition to explore the effect on market performance of alternatives to flat capitation such as severity-adjusted capitation and reduced supply-side cost-sharing. In the model, flat capitation causes severe market problems. Severity adjustment and to a lesser extent reduced supply-side cost-sharing improve market performance, but outcomes are efficient only in cases in which people bear the marginal costs of their choices.