Research Grants

Funding For:

Very High and Low Residual Spenders in Private Health Insurance Markets

Cost & Quality / Health Care Coverage / Prescription Drugs


Tom McGuire, Harvard University

Grant Period:

Jan 01, 2019 - Dec 31, 2019



Summary of the Project:

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.

Media Coverage

August 29, 2020

Very high and low residual spenders in private health insurance markets: Germany, The Netherlands and the U.S. Marketplaces

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Author: Thomas G. McGuire, Sonja Schillo & Richard C. van Kleef