Plan responses to diagnosis-based payment: Evidence from Germany’s morbidity-based risk adjustment

Sebastian Bauhoff, Lisa Fischer, Dirk Göpffarth and Amelie Wuppermann

Journal of Health Economics, 2017, vol. 56, issue C, 397-413

Abstract: Many competitive health insurance markets adjust payments to participating health plans according to their enrollees’ risk − including based on diagnostic information. We investigate responses of German health plans to the introduction of morbidity-based risk adjustment in the Statutory Health Insurance in 2009, which triggers payments based on “validated” diagnoses by providers. Using the regulator’s data from office-based physicians, we estimate a difference-in-difference analysis of the change in the share and number of validated diagnoses for ICD codes that are inside or outside the risk adjustment but are otherwise similar. We find a differential increase in the share of validated diagnoses of 2.6 and 3.6 percentage points (3–4%) between 2008 and 2013. This increase appears to originate from both a shift from not-validated toward validated diagnoses and an increase in the number of such diagnoses. Overall, our results indicate that plans were successful in influencing physicians’ coding practices in a way that could lead to higher payments.

Keywords: Health plan payment; Risk adjustment; Managed competition; Diagnostic coding; German statutory health insurance (search for similar items in EconPapers)
JEL-codes: H51 I1 I13 I18 (search for similar items in EconPapers)
Date: 2017
References: Add references at CitEc
Citations: View citations in EconPapers (5)

Downloads: (external link)
http://www.sciencedirect.com/science/article/pii/S016762961730228X
Full text for ScienceDirect subscribers only

Related works:
Working Paper: Plan Responses to Diagnosis-Based Payment: Evidence from Germany's Morbidity-Based Risk Adjustment (2017)
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:eee:jhecon:v:56:y:2017:i:c:p:397-413

DOI: 10.1016/j.jhealeco.2017.03.001

Access Statistics for this article

Journal of Health Economics is currently edited by J. P. Newhouse, A. J. Culyer, R. Frank, K. Claxton and T. McGuire

More articles in Journal of Health Economics from Elsevier
Bibliographic data for series maintained by Catherine Liu (repec@elsevier.com).