Adjusting Risk Adjustment — Accounting for Variation in Diagnostic Intensity
Author(s)
Gentzkow, Matthew; Finkelstein, Amy; Hull, Peter Davenport; Williams, Heidi L
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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.
Date issued
2017-02Department
Massachusetts Institute of Technology. Department of EconomicsJournal
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
ISSN
0028-4793
1533-4406