1. Risk selection in the Massachusetts State employee health insurance program.
- Author
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Yu, Wei, Ellis, Randall P., Ash, Arlene, Yu, W, Ellis, R P, and Ash, A
- Subjects
PUBLIC health ,EMPLOYEE selection ,MEDICAL care ,HEALTH maintenance organizations ,MANAGED care programs ,DIAGNOSIS related groups ,COMPARATIVE studies ,DISCRIMINATION in insurance ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,RISK assessment ,STATE governments ,USER charges ,EMPLOYER-sponsored health insurance ,COST analysis ,EVALUATION research ,FEE for service (Medical fees) ,STATISTICAL models ,ECONOMICS - Abstract
Using the Diagnostic Cost Group (DCG) model developed from a national sample, we examine biased selection among one fee-for-service (FFS) plan, one preferred provider organization, and several health maintenance organizations (HMOs) in Massachusetts. The proportions of enrollees in low-risk groups are higher in the HMO plans and lower in the FFS plan. The average age in the FFS plan is 9 years greater than that in the HMO plans. Actual premiums are not consistent with risk levels among HMO plans, resulting in gains in some HMO plans and losses in others as high as 20% compared to expected expenses as computed by the DCG model. [ABSTRACT FROM AUTHOR]
- Published
- 2001
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