Risk adjustment and risk selection on the sickness fund insurance market in five European countries

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment-as is the case in all five countries in the year 2001-the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds. [Authors]]]> Health Care Reform ; Insurance Selection Bias ; Managed Competition ; National Health Programs ; Risk Adjustment eng oai:serval.unil.ch:BIB_C1056E4EB1E1 2022-05-07T01:26:22Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_C1056E4EB1E1 Accurate Estimation of Running Temporal Parameters Using Foot-Worn Inertial Sensors info:doi:10.3389/fphys.2018.00610 info:eu-repo/semantics/altIdentifier/doi/10.3389/fphys.2018.00610 info:eu-repo/semantics/altIdentifier/pmid/29946263 Falbriard, M. Meyer, F. Mariani, B. Millet, G.P. Aminian, K. info:eu-repo/semantics/article article 2018 Frontiers in physiology, vol. 9, pp. NA info:eu-repo/semantics/altIdentifier/pissn/1664-042X urn:issn:1664-042X <![CDATA[The aim of this study was to assess the performance of different kinematic features measured by foot-worn inertial sensors for detecting running gait temporal events (e.g., initial contact, terminal contact) in order to estimate inner-stride phases duration (e.g., contact time, flight time, swing time, step time). Forty-one healthy adults ran multiple trials on an instrumented treadmill while wearing one inertial measurement unit on the dorsum of each foot. Different algorithms for the detection of initial contact and terminal contact were proposed, evaluated and compared with a reference-threshold on the vertical ground reaction force. The minimum of the pitch angular velocity within the first and second half of a mid-swing to mid-swing cycle were identified as the most precise features for initial and terminal contact detection with an inter-trial median ± IQR precision of 2 ± 1 ms and 4 ± 2 ms respectively. Using these initial and terminal contact features, this study showed that the ground contact time, flight time, step and swing time can be estimated with an inter-trial median ± IQR bias less than 12 ± 10 ms and the a precision less than 4 ± 3 ms. Finally, this study showed that the running speed can significantly affect the biases of the estimations, suggesting that a speed-dependent correction should be applied to improve the system's accuracy

Gender and health care utilization: The role of mental distress and help-seeking propensity

Many studies report higher levels of health care utilization among women. Understanding how gender influences health care utilization is still unresolved. We developed a model that could explain these gender-related differences. The possible pathways assumed by this model that relate gender to utilization, can be summarized as follows: (1) utilization may be influenced by somatic morbidity, mental distress, perceived symptoms, poor subjective health and propensity to use services; (2) women have higher levels of these variables than men (mediating effect); and (3) the direct effects of some of these variables on utililization are moderated by gender, i.e. they are stronger for women than for men (moderating effect). Data were drawn from a community-based sample of adult enrollees of a sickness fund in the Netherlands, who had responded to a mailed health survey (N=8698). This survey contained questions on somatic morbidity, mental distress and other mediating variables. Health care utilization was measured prospectively, using data extracted from a claims database held by the sickness fund that covers all types of general health services except general practitioner consultations. The model was tested using structural equation modelling. Women reported more somatic morbidity and mental distress than men did, as well as elevated levels of other mediating variables, which might explain--at least partly--gender related differences in utilization. Differences in propensity to use services were not found. The expected moderating effect of gender could not be demonstrated. That is, we did not find gender related differences in the strength of the relations between mental distress, other mediating variables and utilization. Mental distress is related to utilization in a way that is not gender specific, however, because women report higher levels of mental distress (as well as somatic morbidity), this results in a greater utilization of somatic health care services.Mental distress Health care utilization Gender differences Structural equation modelling The Netherlands

The Use of Disease-Specific Outcome Measures in Cost-Utility Analysis: The Development of Dutch Societal Preference Weights for the FACT-L Scale

Introduction: The Functional Assessment of Cancer Therapy-Lung (FACT-L) is a validated, sensitive and reliable patient questionnaire that evaluates and quantifies quality of life (QOL) across several domains, including lung cancer-related symptoms. The FACT-L was not designed for use in economic evaluation and does not incorporate preferences into its scoring system. Objective: To derive a set of Dutch preference weights for FACT-L health states that can be used to convert FACT-L into a single value that can be used in cost-utility analyses. Methods: A representative sample of the Dutch population (n_=_1076) directly valued an orthogonal set of eight FACT-L health states on a 100-point rating scale with the anchor points `worst imaginable health state' and `best imaginable health state'. Eleven FACT-L items were selected to describe the FACT-L health states that were directly valued. Regression analysis was used to interpolate values for all other possible health states. Scores were transformed into values on a scale where 0 indicated dead and 1 indicated full health. Results: The estimated values for FACT-L health states ranged from 0.08 to 0.93. The estimated value sets were applied to FACT-L data of lung cancer patients participating in a clinical study. Significant differences in the mean value and mean gain of 0.12 and 0.07, respectively, were found between patients in remission and patients with progressive disease at 4 weeks' follow-up. Conclusion: Our results reaffirmed that the methodology used here is a feasible option to convert data collected with a disease-specific outcome measure into preferences. We concluded that the sensitivity of the derived set of societal preferences to capture differences and changes in clinical health states is an indication of its construct validity.Lung-cancer, Quality-of-life, Utility-measurement