René C J A Van Vliet
Dados Biográficos
| ID | 1267147 |
|---|---|
| NOME | René C J A Van Vliet |
| PRENOMES | René C J A |
| SOBRENOME | Van Vliet |
| ASSINATURA | VAN VLIET R C J A |
| AFILIAÇÕES | Erasmus University Rotterdam |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 13 |
| TOTAL DE CITAÇÕES | 5 |
| TOTAL COMO AUTOR | 13 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1989 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2024 |
| ÍNDICE H | 2 |
Risk Adjustment in Health Insurance Markets
OBJECTIVES: The goals of this paper are: (1) to identify groups of healthy people; and (2) to quantify the extent to which the Dutch risk adjustment (RA) model overpays insurers for these groups. BACKGROUND: There have been strong signals that insurers in the Dutch regulated health insurance market engage in actions to attract healthy people. A potential explanation for this behavior is that the Dutch RA model overpays insurers for healthy people…
Diagnosis-based Cost Groups in the Dutch Risk-equalization Model
BACKGROUND: The risk-equalization (RE) model in the Dutch health insurance market has evolved to a sophisticated model containing direct proxies for health. However, it still has important imperfections, leaving incentives for risk selection. This paper focuses on refining an important health-based risk-adjuster in this model: the diagnosis-based costs groups (DCGs). The current (2017) DCGs are calibrated on "old" data of 2011/2012, are mutually …
Profiling Individual Physicians Using Administrative Data From a Single Insurer
BACKGROUND: Individual physicians are increasingly being subjected to comparative performance assessments. When single-insurer data are used to profile individual physicians' performance, reliable measurements are uncertain because of small sample sizes. METHODS: Administrative data (2006-2008) from a Dutch insurer are used to examine variation in general practitioners' (GPs) performance on expenses (5 measures), utilization of hospital care (2 m…
A new prevention paradox
Improving Risk Equalization Using Multiple-year High Cost as a Health Indicator
BACKGROUND: More and more competitive health insurance markets use risk equalization to compensate health plans for the predictable high costs of chronically ill enrollees. In the presence of premium rate restrictions, an important goal of risk equalization is to reduce incentives for selection, while maintaining incentives for efficiency. The literature shows, however, that even the most sophisticated risk equalization models--which include both…
Risk-Adjusting the Doughnut Hole to Improve Efficiency and Equity
An important goal of consumer cost-sharing in health insurance is to increase incentives for cost containment. A relatively new cost-sharing phenomenon is the "doughnut hole": a gap in coverage starting at a predefined level of medical expenses. An important question is where to locate the starting point to achieve the strongest incentives for cost containment. We argue that the answer depends on an individual's health status. Using data from a D…
Prior Use of Durable Medical Equipment as a Risk Adjuster for Health-Based Capitation
This paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a risk adjuster for capitation payments in the subsequent year. We evaluate 143 DME types in terms of incentives, validity, predictive value, and measurability, res…
Diagnostic, Pharmacy-Based, and Self-Reported Health Measures in Risk Equalization Models
BACKGROUND: Current research on the added value of self-reported health measures for risk equalization modeling does not include all types of self-reported health measures; and/or is compared with a limited set of medically diagnosed or pharmacy-based diseases; and/or is limited to specific populations of high-risk individuals. OBJECTIVE: The objective of our study is to determine the predictive power of all types of self-reported health measures…
Health-Based Risk Adjustment
Since 1991, risk-adjusted premium subsidies have existed in the Dutch social health insurance sector, which covered about two-thirds of the population until 2006. In 2002, pharmacy-based cost groups (PCGs) were included in the demographic risk adjustment model, which improved the goodness-of-fit, as measured by the R2, to 11.5%. The model's R2 reached 22.8% in 2004, when inpatient diagnostic information was added in the form of diagnostic cost gr…
Costs in the Last Year of Life in the Netherlands
The costs of health care in the last year of life are a subject of debate and myth. Expensive interventions at the end of life often are blamed for the rapid increase in health care spending, but evidence about the existence of such exceptionally high expenditures at the end of life is rare and faulty. This investigation examines the development and composition of health care costs at the end of life for all age groups in The Netherlands. In cont…
The High Costs of Death
OBJECTIVES: Since 1993, major reforms have been implemented in the Dutch social health insurance system. The competing sickness funds receive risk-adjusted capitation payments based on age, gender, region, and a disability indicator. As these very crude health indicators do not reflect expected costs accurately, an extensive ex post equalization between sickness funds takes place. Mortality has been suggested as an additional risk adjuster, mainl…
Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market
"A built bed is a filled bed?" An empirical re-examination
"A built bed is a filled bed?" An empirical re-examination
The High Costs of Death
OBJECTIVES: Since 1993, major reforms have been implemented in the Dutch social health insurance system. The competing sickness funds receive risk-adjusted capitation payments based on age, gender, region, and a disability indicator. As these very crude health indicators do not reflect expected costs accurately, an extensive ex post equalization between sickness funds takes place. Mortality has been suggested as an additional risk adjuster, mainl…
Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market
Costs in the Last Year of Life in the Netherlands
The costs of health care in the last year of life are a subject of debate and myth. Expensive interventions at the end of life often are blamed for the rapid increase in health care spending, but evidence about the existence of such exceptionally high expenditures at the end of life is rare and faulty. This investigation examines the development and composition of health care costs at the end of life for all age groups in The Netherlands. In cont…
Health-Based Risk Adjustment
Since 1991, risk-adjusted premium subsidies have existed in the Dutch social health insurance sector, which covered about two-thirds of the population until 2006. In 2002, pharmacy-based cost groups (PCGs) were included in the demographic risk adjustment model, which improved the goodness-of-fit, as measured by the R2, to 11.5%. The model's R2 reached 22.8% in 2004, when inpatient diagnostic information was added in the form of diagnostic cost gr…
Prior Use of Durable Medical Equipment as a Risk Adjuster for Health-Based Capitation
This paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a risk adjuster for capitation payments in the subsequent year. We evaluate 143 DME types in terms of incentives, validity, predictive value, and measurability, res…
Diagnostic, Pharmacy-Based, and Self-Reported Health Measures in Risk Equalization Models
BACKGROUND: Current research on the added value of self-reported health measures for risk equalization modeling does not include all types of self-reported health measures; and/or is compared with a limited set of medically diagnosed or pharmacy-based diseases; and/or is limited to specific populations of high-risk individuals. OBJECTIVE: The objective of our study is to determine the predictive power of all types of self-reported health measures…
Risk-Adjusting the Doughnut Hole to Improve Efficiency and Equity
An important goal of consumer cost-sharing in health insurance is to increase incentives for cost containment. A relatively new cost-sharing phenomenon is the "doughnut hole": a gap in coverage starting at a predefined level of medical expenses. An important question is where to locate the starting point to achieve the strongest incentives for cost containment. We argue that the answer depends on an individual's health status. Using data from a D…
Improving Risk Equalization Using Multiple-year High Cost as a Health Indicator
BACKGROUND: More and more competitive health insurance markets use risk equalization to compensate health plans for the predictable high costs of chronically ill enrollees. In the presence of premium rate restrictions, an important goal of risk equalization is to reduce incentives for selection, while maintaining incentives for efficiency. The literature shows, however, that even the most sophisticated risk equalization models--which include both…
Profiling Individual Physicians Using Administrative Data From a Single Insurer
BACKGROUND: Individual physicians are increasingly being subjected to comparative performance assessments. When single-insurer data are used to profile individual physicians' performance, reliable measurements are uncertain because of small sample sizes. METHODS: Administrative data (2006-2008) from a Dutch insurer are used to examine variation in general practitioners' (GPs) performance on expenses (5 measures), utilization of hospital care (2 m…
A new prevention paradox
Diagnosis-based Cost Groups in the Dutch Risk-equalization Model
BACKGROUND: The risk-equalization (RE) model in the Dutch health insurance market has evolved to a sophisticated model containing direct proxies for health. However, it still has important imperfections, leaving incentives for risk selection. This paper focuses on refining an important health-based risk-adjuster in this model: the diagnosis-based costs groups (DCGs). The current (2017) DCGs are calibrated on "old" data of 2011/2012, are mutually …
Risk Adjustment in Health Insurance Markets
OBJECTIVES: The goals of this paper are: (1) to identify groups of healthy people; and (2) to quantify the extent to which the Dutch risk adjustment (RA) model overpays insurers for these groups. BACKGROUND: There have been strong signals that insurers in the Dutch regulated health insurance market engage in actions to attract healthy people. A potential explanation for this behavior is that the Dutch RA model overpays insurers for healthy people…
Medicine (12 obras) · Healthcare Policy and Management (11 obras) · Actuarial science (10 obras) · Economics (10 obras) · Business (9 obras) · Computer Science (8 obras) · Health Systems, Economic Evaluations, Quality of Life (8 obras) · Health care (7 obras) · Environmental health (5 obras) · Finance (5 obras)