Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration

Very High and Low Residual Spenders in Private Health Insurance Markets

Tom McGuire, Harvard University

January 01, 2019
December 31, 2019

This study will use major claims databases from the U.S., The Netherlands and Germany to explore the need to improve the accuracy of health plan payments in private health insurance markets and understand the impact of several possible approaches for making such improvements. Focusing on patients for whom actual plan spending is either very significantly above or below the risk adjusted payment for the patient (positive and negative residual spenders), the investigators will describe patient characteristics that may affect spending and model how remedial strategies such as residual spending reinsurance, changes to risk-adjustment factors and policies to address high drug costs would affect the performance of the payment system. Findings hold the potential to improve payment accuracy and promote more efficient functioning of private health insurance markets.