Risk adjustment for regional healthcare funding allocations with ensemble methods: an empirical study and interpretation
Author
Abstract
Suggested Citation
DOI: 10.1007/s10198-023-01656-w
Download full text from publisher
As the access to this document is restricted, you may want to search for a different version of it.
References listed on IDEAS
- Michael Geruso & Timothy Layton & Daniel Prinz, 2019.
"Screening in Contract Design: Evidence from the ACA Health Insurance Exchanges,"
American Economic Journal: Economic Policy, American Economic Association, vol. 11(2), pages 64-107, May.
- Michael Geruso & Timothy J. Layton & Daniel Prinz, 2016. "Screening in Contract Design: Evidence from the ACA Health Insurance Exchanges," NBER Working Papers 22832, National Bureau of Economic Research, Inc.
- Alexandre Vimont & Henri Leleu & Isabelle Durand-Zaleski, 2022. "Machine learning versus regression modelling in predicting individual healthcare costs from a representative sample of the nationwide claims database in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(2), pages 211-223, March.
- Peter C. Smith & Nigel Rice & Roy Carr‐Hill, 2001. "Capitation funding in the public sector," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 164(2), pages 217-257.
- Kurt Lavetti & Kosali Simon, 2018.
"Strategic Formulary Design in Medicare Part D Plans,"
American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 154-192, August.
- Kurt Lavetti & Kosali Simon, 2016. "Strategic Formulary Design in Medicare Part D Plans," NBER Working Papers 22338, National Bureau of Economic Research, Inc.
- Sungchul Park & Anirban Basu, 2018. "Alternative evaluation metrics for risk adjustment methods," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 984-1010, June.
- Randall P. Ellis & Denzil G. Fiebig & Meliyanni Johar & Glenn Jones & Elizabeth Savage, 2013.
"Explaining Health Care Expenditure Variation: Large‐Sample Evidence Using Linked Survey And Health Administrative Data,"
Health Economics, John Wiley & Sons, Ltd., vol. 22(9), pages 1093-1110, September.
- Randall P. Ellis & Denzil G. Fiebig & Meliyanni Johar & Glenn Jones & Elizabeth Savage, 2012. "Explaining Health Care Expenditure Variation: Large-sample Evidence Using Linked Survey and Health Administrative Data," Working Paper Series 1, Economics Discipline Group, UTS Business School, University of Technology, Sydney.
- Mark Shepard, 2022. "Hospital Network Competition and Adverse Selection: Evidence from the Massachusetts Health Insurance Exchange," American Economic Review, American Economic Association, vol. 112(2), pages 578-615, February.
- Wynand Ven & Gerrit Hamstra & Richard Kleef & Mieke Reuser & Piet Stam, 2023. "The goal of risk equalization in regulated competitive health insurance markets," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(1), pages 111-123, February.
- S. Veen & R. Kleef & W. Ven & R. Vliet, 2015. "Improving the prediction model used in risk equalization: cost and diagnostic information from multiple prior years," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(2), pages 201-218, March.
- Richard C. van Kleef & René C. J. A. van Vliet, 2022. "How to deal with persistently low/high spenders in health plan payment systems?," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 784-805, May.
- Andrew M. Jones & James Lomas & Nigel Rice, 2015. "Healthcare Cost Regressions: Going Beyond the Mean to Estimate the Full Distribution," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1192-1212, September.
- Andrew M. Jones & James Lomas & Peter T. Moore & Nigel Rice, 2016. "A quasi-Monte-Carlo comparison of parametric and semiparametric regression methods for heavy-tailed and non-normal data: an application to healthcare costs," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 951-974, October.
- Kauer, Lukas & McGuire, Thomas G. & Beck, Konstantin, 2020. "Extreme under and overcompensation in morbidity-based health plan payments: The case of Switzerland," Health Policy, Elsevier, vol. 124(1), pages 61-68.
- Florian Buchner & Jürgen Wasem & Sonja Schillo, 2017. "Regression Trees Identify Relevant Interactions: Can This Improve the Predictive Performance of Risk Adjustment?," Health Economics, John Wiley & Sons, Ltd., vol. 26(1), pages 74-85, January.
- S. H. C. M. van Veen & R. C. van Kleef & W. P. M. M. van de Ven & R. C. J. A. van Vliet, 2018. "Exploring the predictive power of interaction terms in a sophisticated risk equalization model using regression trees," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 1-12, February.
- Marica Iommi & Savannah Bergquist & Gianluca Fiorentini & Francesco Paolucci, 2022. "Comparing risk adjustment estimation methods under data availability constraints," Health Economics, John Wiley & Sons, Ltd., vol. 31(7), pages 1368-1380, July.
- Peter C. Smith, 2003. "Formula Funding of Public Services: An Economic Analysis," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 19(2), pages 301-322, Summer.
- I. Duncan & M. Loginov & M. Ludkovski, 2016. "Testing Alternative Regression Frameworks for Predictive Modeling of Health Care Costs," North American Actuarial Journal, Taylor & Francis Journals, vol. 20(1), pages 65-87, January.
Most related items
These are the items that most often cite the same works as this one and are cited by the same works as this one.- Alexandre Vimont & Henri Leleu & Isabelle Durand-Zaleski, 2022. "Machine learning versus regression modelling in predicting individual healthcare costs from a representative sample of the nationwide claims database in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(2), pages 211-223, March.
- Bergquist, Savannah L. & Layton, Timothy J. & McGuire, Thomas G. & Rose, Sherri, 2019. "Data transformations to improve the performance of health plan payment methods," Journal of Health Economics, Elsevier, vol. 66(C), pages 195-207.
- Sungchul Park & Anirban Basu, 2018. "Alternative evaluation metrics for risk adjustment methods," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 984-1010, June.
- Marica Iommi & Savannah Bergquist & Gianluca Fiorentini & Francesco Paolucci, 2022. "Comparing risk adjustment estimation methods under data availability constraints," Health Economics, John Wiley & Sons, Ltd., vol. 31(7), pages 1368-1380, July.
- Michele Fioretti & Hongming Wang, 2023.
"Performance Pay in Insurance Markets: Evidence from Medicare,"
The Review of Economics and Statistics, MIT Press, vol. 105(5), pages 1128-1144, September.
- Michele Fioretti & Hongming Wang, 2020. "Performance Pay in Insurance Markets: Evidence from Medicare," Working Papers 2020.03, International Network for Economic Research - INFER.
- Michele Fioretti & Hongming Wang, 2021. "Performance Pay in Insurance Markets: Evidence from Medicare," Post-Print hal-03791843, HAL.
- Michele Fioretti & Hongming Wang, 2021. "Performance Pay in Insurance Markets: Evidence from Medicare," SciencePo Working papers Main hal-03386584, HAL.
- Michele Fioretti & Hongming Wang, 2021. "Performance Pay in Insurance Markets: Evidence from Medicare," SciencePo Working papers Main hal-03791843, HAL.
- Michele Fioretti & Hongming Wang, 2021. "Performance Pay in Insurance Markets: Evidence from Medicare," SciencePo Working papers hal-03386584, HAL.
- Michele Fioretti & Hongming Wang, 2021. "Performance Pay in Insurance Markets: Evidence from Medicare," Working Papers hal-03386584, HAL.
- David Dranove & Christopher Ody & Amanda Starc, 2021.
"A Dose of Managed Care: Controlling Drug Spending in Medicaid,"
American Economic Journal: Applied Economics, American Economic Association, vol. 13(1), pages 170-197, January.
- David Dranove & Christopher Ody & Amanda Starc, 2017. "A Dose of Managed Care: Controlling Drug Spending in Medicaid," NBER Working Papers 23956, National Bureau of Economic Research, Inc.
- Michael Geruso & Timothy J. Layton & Grace McCormack & Mark Shepard, 2023.
"The Two-Margin Problem in Insurance Markets,"
The Review of Economics and Statistics, MIT Press, vol. 105(2), pages 237-257, March.
- Geruso, Michael & Layton, Timothy J. & McCormack, Grace & Shepard, Mark, 2019. "The Two Margin Problem in Insurance Markets," Working Paper Series rwp19-035, Harvard University, John F. Kennedy School of Government.
- Michael Geruso & Timothy J. Layton & Grace McCormack & Mark Shepard, 2019. "The Two Margin Problem in Insurance Markets," NBER Working Papers 26288, National Bureau of Economic Research, Inc.
- Adam Oliver, 2005. "The English National Health Service: 1979‐2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 75-99, September.
- Peter Paul Klein & Richard van Kleef & Josefa Henriquez & Francesco Paolucci, 2023. "The interplay between risk adjustment and risk rating in voluntary health insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 90(1), pages 59-91, March.
- repec:spo:wpecon:info:hdl:2441/2ioennpq5m90holakkatq7cmms is not listed on IDEAS
- repec:spo:wpmain:info:hdl:2441/4bg68glinb8r8roh0akvprtu9u is not listed on IDEAS
- Jeffrey P. Clemens & Jonathan M. Leganza & Alex Masucci, 2021.
"Plugging Gaps in Payment Systems: Evidence from the Take-Up of New Medicare Billing Codes,"
CESifo Working Paper Series
9209, CESifo.
- Jeffrey Clemens & Jonathan M. Leganza & Alex Masucci, 2023. "Plugging Gaps in Payment Systems: Evidence from the Take-Up of New Medicare Billing Codes," NBER Working Papers 31336, National Bureau of Economic Research, Inc.
- Michael Geruso & Timothy J. Layton, 2017.
"Selection in Health Insurance Markets and Its Policy Remedies,"
Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 23-50, Fall.
- Michael Geruso & Timothy Layton, 2017. "Selection in Health Insurance Markets and Its Policy Remedies," NBER Working Papers 23876, National Bureau of Economic Research, Inc.
- Jonathan Gruber, 2017. "Delivering Public Health Insurance through Private Plan Choice in the United States," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 3-22, Fall.
- Fleitas, Sebastian & Gowrisankaran, Gautam & Lo Sasso, Anthony, 2022. "Incumbent regulation and adverse selection: You can keep your health plan, but at what cost?," Journal of Public Economics, Elsevier, vol. 205(C).
- Kreider, Amanda R. & Layton, Timothy J. & Shepard, Mark & Wallace, Jacob, 2024.
"Adverse selection and network design under regulated plan prices: Evidence from Medicaid,"
Journal of Health Economics, Elsevier, vol. 97(C).
- Amanda R. Kreider & Timothy J. Layton & Mark Shepard & Jacob Wallace, 2022. "Adverse Selection and Network Design Under Regulated Plan Prices: Evidence from Medicaid," NBER Working Papers 30719, National Bureau of Economic Research, Inc.
- Anna Zink & Sherri Rose, 2020. "Fair regression for health care spending," Biometrics, The International Biometric Society, vol. 76(3), pages 973-982, September.
- Martin Gaynor & Kate Ho & Robert J. Town, 2015.
"The Industrial Organization of Health-Care Markets,"
Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
- Martin Gaynor & Kate Ho & Robert Town, 2014. "The Industrial Organization of Health Care Markets," NBER Working Papers 19800, National Bureau of Economic Research, Inc.
- Benjamin R. Handel & Kate Ho, 2021. "Industrial Organization of Health Care Markets," NBER Working Papers 29137, National Bureau of Economic Research, Inc.
- Longden, Thomas & Wong, Chun Yee & Haywood, Philip & Hall, Jane & van Gool, Kees, 2018. "The prevalence of persistence and related health status: An analysis of persistently high healthcare costs in the short term and medium term," Social Science & Medicine, Elsevier, vol. 211(C), pages 147-156.
- repec:hal:spmain:info:hdl:2441/4bg68glinb8r8roh0akvprtu9u is not listed on IDEAS
- A. A. Withagen-Koster & R. C. Kleef & F. Eijkenaar, 2018. "Examining unpriced risk heterogeneity in the Dutch health insurance market," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(9), pages 1351-1363, December.
- Savannah L. Bergquist & Timothy J. Layton & Thomas G. McGuire & Sherri Rose, 2018. "Intervening on the Data to Improve the Performance of Health Plan Payment Methods," NBER Working Papers 24491, National Bureau of Economic Research, Inc.
- repec:hal:wpspec:info:hdl:2441/4bg68glinb8r8roh0akvprtu9u is not listed on IDEAS
- Michele Fioretti & Hongming Wang, 2019.
"Subsidizing Inequality: Performance Pay and Risk Selection in Medicare,"
Working Papers
hal-03393070, HAL.
- Michele Fioretti & Hongming Wang, 2019. "Subsidizing Inequality: Performance Pay and Risk Selection in Medicare," SciencePo Working papers Main hal-03393070, HAL.
- Michele Fioretti & Hongming Wang, 2019. "Subsidizing Inequality: Performance Pay and Risk Selection in Medicare," SciencePo Working papers hal-03393070, HAL.
More about this item
Keywords
Risk adjustment; Predictive modeling; Healthcare costs; Socioeconomic information; Machine learning; Interpretation;All these keywords.
JEL classification:
- H72 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Budget and Expenditures
- H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
- I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
Statistics
Access and download statisticsCorrections
All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:25:y:2024:i:7:d:10.1007_s10198-023-01656-w. See general information about how to correct material in RePEc.
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .
Please note that corrections may take a couple of weeks to filter through the various RePEc services.