Public policy towards health insurance is guided by principles of managed competition in Belgium, Germany, Israel, the Netherlands, Switzerland, and other countries in Asia and Latin America, as well as of key sectors in the United States, including the Medicare Advantage program for Medicare beneficiaries, state-level Marketplaces created as part of the Affordable Care Act (2010) and state Medicaid managed care programs. While there is considerable heterogeneity in some aspects of the policies in these different sectors, there are also many commonalities. In all of these sectors, individuals choose among private plans that compete on price (i.e. the premium) and quality (e.g. in terms of provider network). Common regulatory aspects include standardized coverage, premium regulation and open enrollment (the senses in which competition is “managed”).
A common challenge in these sectors is to pay health plans in a way that stimulates market efficiency and – at the same time – protects public objectives like individual affordability, fairness and no risk selection. This Special Issue of the Journal of Health Economics aims to bring together current research on health plan payment in health insurance markets fitting within the managed competition paradigm (broadly defined). We seek an intellectually cohesive set of papers on topics that would be of interest to researchers and policymakers in the US and internationally. The issue will consist of 8-12 papers in total, with 2-3 review papers and 6-9 papers with new research.
Topics suitable for inclusion in the Special Issue include: Evaluation of the effect of plan payment on economic performance of the market, e.g., the effect of improved risk adjustment or lock-in periods in Medicare Advantage.
- Methods for estimating risk adjustment weights
- Adverse selection incentives and plan payment
- Incorporating SES and/or survey information into risk adjustment formula
- Economics of plan payment features such as premium groups and reinsurance
- Methods for ex ante evaluation of plan payment formula
- Methods for selecting risk adjustor variables when indicators are endogenous (via, e.g., “gaming”)
- Plan payment methods in the presence of imperfect competition among insurers (or providers), or in the presence of other market failures
Manuscripts should be prepared according to the guidelines outlined on the website of the Journal of Health Economics.
Manuscripts should be submitted by October 1, 2016 through the Elsevier Editorial System at http://ees.elsevier.com/jhe/. Authors should select “Special Issue: Health Plan Payment” as article type, and also indicate in the cover letter that the manuscript should be considered for the special issue.
The website will open for submissions to the Special Issue on June 11, 2016.
Thomas McGuire and Richard van Kleef, Guest Editors