High-risk pooling for mitigating risk selection incentives in health insurance markets with sophisticated risk equalization:an application based on health survey information

Background: Despite sophisticated risk equalization, insurers in regulated health insurance markets still face incentives to attract healthy people and avoid the chronically ill because of predictable differences in profitability between these groups. The traditional approach to mitigate such incentives for risk selection is to improve the risk-equalization model by adding or refining risk adjusters. However, not all potential risk adjusters are appropriate. One example are risk adjusters based on health survey information. Despite its predictiveness of future healthcare spending, such information is generally considered inappropriate for risk equalization, due to feasibility challenges and a potential lack of representativeness. Methods: We study the effects of high-risk pooling (HRP) as a strategy for mitigating risk selection incentives in the presence of sophisticated– though imperfect– risk equalization. We simulate a HRP modality in which insurers can ex-ante assign predictably unprofitable individuals to a ‘high risk pool’ using information from a health survey. We evaluate the effect of five alternative pool sizes based on predicted residual spending post risk equalization on insurers’ incentives for risk selection and cost control, and compare this to the situation without HRP. Results: The results show that HRP based on health survey information can substantially reduce risk selection incentives. For example, eliminating the undercompensation for the top-1% with the highest predicted residual spending reduces selection incentives against the total group with a chronic disease (60% of the population) by approximately 25%. Overall, the selection incentives gradually decrease with a larger pool size. The largest marginal reduction is found moving from no high-risk pool to HRP for the top 1% individuals with the highest predicted residual spending. Conclusion: Our main conclusion is that HRP has the potential to considerably reduce remaining risk selection incentives at the expense of a relatively small reduction of incentives for cost control. The extent to which this can be achieved, however, depends on the design of the high-risk pool.</p

Some rare and new caddis flies recorded for the Netherlands (Trichoptera)

Contains fulltext : 35412.pdf (publisher's version ) (Open Access)Since Higler published his list of extinct and endangered caddis flies species in 1995 a number of new and rare species were recorded for the Netherlands. These new findings can be partly attributed to the growing interest among researchers to study caddis flies, which has resulted in a more thorough investigation of certain water types. Other records of rare species were discovered by collecting and identifying pupae and adults, such as Hydroptila vectis and Oxyethira falcata. Some rare species, which have not been recorded since 1950, are common nowadays, possibly caused by the improved water quality of the river systems in the Netherlands. Other new species to the Dutch fauna are the result of new taxonomic insights

Samengestelde, peilgestuurde drainage in Nederland : voortgangsrapport 1

Verslag van het eerste uitvoeringsjaar van het project ‘Drainage tegen verdroging en voor een beter milieu; veldonderzoek naar het functioneren van samengestelde peilgestuurde drainage.’ Binnen dit project ligt de proeflocatie Ospel. In dit project willen wij hier configuraties van samengestelde, peilgestuurde drainage systemen vergelijken, en tegelijkertijd effect kwantificeren van ongedraineerd perceel op groeiomstandigheden, verloop van het gehalte aan bodemvocht en de kwaliteit van het ondiepe grondwate

UvA-DARE (Digital Academic Repository) Facing differences with an open mind: Openness to experience, salience of intra-group differences, and performance of diverse work groups

. (2008). Facing differences with an open mind: Openness to experience, salience of intra-group differences, and performance of diverse work groups