RAHI / Risk Adjustment in Health Insurance

The project RAHI analyzes insurer competition under premium regulation. A risk adjustment scheme was introduced in Germany in order to eliminate or mitigate risk selection by insurers. Risk adjustment ensures fair competition and fosters the efficient provision of health care. The project’s objective is to identify the optimal risk factors for the risk adjustment scheme.

The first project period covered, among other things, the adaptation of regression trees to the object of the German risk adjustment scheme and a study on concepts of a high-risk pool under the conditions of risk adjustment, which contributed to the debate on the financing of SHIFs in Germany.

The subject of the second project period is the analysis of the previously scarcely investigated interplay of multiple morbidity orientation in the German health care system (risk adjusted SHIFs’ payment scheme, Diagnosis Related Groups (DRGs) in the inpatient payment system, morbidity-related total amount in the outpatient system) with the aim of identifying conflicting goals between and within the mechanisms, elaborating undesirable effects such as incentives for upcoding, inefficiency and risk selection, and presenting proposals for a corresponding further development of the competition regime. In this context, reform contributions (such as the proposal formulated by health insurance funds to switch from a prospective to a concurrent risk adjustment model) are to be assessed against the background of the interplay of the different morbidity-related payment systems. Therefore, this research project is not only focused on scientific publications, but also aims at the integration or information of health policy decision makers.

Publications

  • Schillo, S., Lux, G., Wasem, J. and F. Buchner (2016): High cost pool or high cost groups - how to handel high(est) cost cases in a risk adjustment mechanism? Health Policy, 120(2), 141-147.
  • Biermann, J., Neumann, T., Angermann, C.E., Düngen, H.D., Erbel, R., Herzog, W., Maisch, B., Müller-Tasch, T., Özcelik, C., Pankuweit, S., Pieske, B., Pittrow, D., Regnitz-Zagrosek, R., Scheffold, T., Störk, S., Wachter, R., Gelbrich, G., Wasem, J. and A. Neumann (2012): Resource use and costs in systolic heart failure according to disease severity: a pooled analysis from the German Competence Network Heart Failure. Public Health, 20, 23-30.
  • Greß, S., A. Focke, F. Hessel and J. Wasem (2006): Financial Incentives for Disease Management Programmes and Integrated Care in German Social Health Insurance, Health Pol 78, 295-305.
  • Buchner, F. and J. Wasem (2003): Needs for further Improvement? Risk Adjustment in the German health insurance system. Health Pol 65, 21-35.
  • Jacobs, K., P. Reschke, D. Cassel and J. Wasem (2002): Zur Wirkung des Risikostrukturausgleichs in der gesetzlichen Krankenversicherung. Eine Untersuchung im Auftrag des Bundesministeriums für Gesundheit. Nomos, Baden-Baden.