Adjusting Risk Adjustment — Accounting for Variation in Diagnostic Intensity
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nejmp1613238.pdf
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Author(s)
Gentzkow, Matthew
Finkelstein, Amy
Hull, Peter Davenport
Williams, Heidi L
Date Issued
February 2017
Journal
New England Journal of Medicine
Publisher
New England Journal of Medicine
Citation
Finkelstein, Amy, Matthew Gentzkow, Peter Hull, and Heidi Williams. “Adjusting Risk Adjustment — Accounting for Variation in Diagnostic Intensity.” New England Journal of Medicine 376, no. 7 (February 16, 2017): 608–610. © 2017 Massachusetts Medical Society
Version
Final published version
Abstract
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicker or harder-to-treat patients and insurers aren’t penalized for covering them. For example, the private insurance companies that participate in Medicare Advantage and the Affordable Care Act (ACA) exchanges receive risk-adjusted payments from the U.S. government, with the rationale that insurers should be reimbursed more for enrollees with higher expected costs.
MIT Department
Massachusetts Institute of Technology. Department of Economics
Terms of Use
Article is made available in accordance with the publisher's policy and may be subject to US copyright law. Please refer to the publisher's site for terms of use.
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DOI of Published Version
https://doi.org/10.1056/NEJMP1613238
