Risk-adjusted capitation: recent experiences in The Netherlands

• Published in: Health Affairs 1994, Vol.13 (5), p.120-136
• Main Authors: van de Ven, W P, van Vliet, R C, van Barneveld, E M, Lamers, L M
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Capitation; Capitation Fee - legislation & jurisprudence; Capitation Fee - organization & administration; Chronic illnesses; Competition; Consumers; Costs; Costs and Cost Analysis - methods; Efficiency; General aspects; Health care; Health care expenditures; Health care policy; Health Care Reform - economics; Health insurance; Health maintenance organizations; Health risk assessment; Health risks; Health systems. Social services; HMOs; Hospitalization; Insurance Benefits - economics; Insurance Benefits - legislation & jurisprudence; Insurance premiums; Insurance Selection Bias; Managed care; Managed competition; Medical sciences; Medicare; National Health Programs - economics; Netherlands; Patients; Payments; Prescription drugs; Profits; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reforms; Regulation; Risk; Skimming; Statistical analysis; Studies; Subsidies
• ISSN: 0278-2715; 1544-5208; 2694-233X
• DOI: 10.1377/hlthaff.13.5.120

The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch reforms and of our research concerning risk-adjusted capitation payments. Although we are optimistic about the technical possibilities for solving the problem of cream skimming, the implementation of good risk-adjusted capitation is a long-term challenge.