jueves, 10 de abril de 2014

AHRQ Study Finds Adverse Selection Potential With Affordable Care Act Coverage

The Affordable Care Act is designed to ensure that health plans cover both high-risk and low-risk people, but there still may be incentives for plans to dissuade individuals with certain medical conditions from enrolling, according to a new study using AHRQ databases. The study finds the possibility of incentives for adverse selection – the disproportionately high enrollment of high-risk, high-cost people in a health plan – especially for those with costly conditions such as mental health/substance abuse and cancer. The study’s authors used AHRQ’s Medical Expenditure Panel Survey data and predictive modeling to assess incentives of health plans in the new health insurance marketplaces mandated in the Affordable Care Act. The study abstract, “Assessing Incentives for Service-Level Selection in Private Health Insurance Exchanges,” was published online February 17 in Journal of Health Economics. Coauthors included AHRQ’s Samuel Zuvekas.

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2014 Feb 17;35C:47-63. doi: 10.1016/j.jhealeco.2014.01.009. [Epub ahead of print]

Assessing incentives for service-level selection in private health insurance exchanges.

McGuire TG1, Newhouse JP2, Normand SL3, Shi J4, Zuvekas S5.

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Abstract

Even with open enrollment and mandated purchase, incentives created by adverse selection may undermine the efficiency of service offerings by plans in the new health insurance Exchanges created by the Affordable Care Act. Using data on persons likely to participate in Exchanges drawn from five waves of the Medical Expenditure Panel Survey, we measure plan incentives in two ways. First, we construct predictive ratios, improving on current methods by taking into account the role of premiums in financing plans. Second, relying on an explicit model of plan profit maximization, we measure incentives based on the predictability and predictiveness of various medical diagnoses. Among the chronic diseases studied, plans have the greatest incentive to skimp on care for cancer, and mental health and substance abuse.