Risk Pooling in Health Care Finance

Topics: Health economics, Health care, Medicine Pages: 70 (18568 words) Published: January 14, 2013
Risk Pooling in Health Care Finance
Peter C. Smith and Sophie N. Witter
Centre for Health Economics
University of York
York YO10 5DD
United Kingdom

Report prepared for the World Bank Workshop
Resource Allocation and Purchasing in Health: Value for Money, Reaching the Poor World Bank, Washington DC, May 14-15 2001

Revised November 2001

Phone
Fax
E-mail

+ 44 1904 433779
+ 44 1904 433759
pcs1@york.ac.uk

Acknowledgements
The authors would like to thank Jack Langenbrunner, Maureen Lewis, Alex Preker and Paul Shaw of the World Bank, Philip Davies of the World Health Organization, and participants at the workshop for comments.

Risk Pooling in Health Care Finance
Contents
RISK POOLING IN HEALTH CARE FINANCE...............................................................................................................1 CONTENTS ....................................................................................................................................................................................1 EXECUTIVE SUMMARY..........................................................................................................................................................1 RISK POOLING IN HEALTH CARE FINANCE...............................................................................................................3 1

INTRODUCTION...............................................................................................................................................................3

2

WHY RISK POOLING IN HEALTH CARE FINANCE? ......................................................................................3

3

APPROACHES TO RISK POOLING..........................................................................................................................7 3.1
3.2
3.3
3.4

4

NO RISK POOLING ............................................................................................................................................................. 7 UNITARY RISK POOL ......................................................................................................................................................... 9 FRAGMENTED RISK POOLS............................................................................................................................................. 10 INTEGRATED RISK POOLS............................................................................................................................................... 12

PRACTICAL ISSUES .....................................................................................................................................................14 4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8

THE INSTITUTIONAL FRAMEWORK FOR RISK POOLING.............................................................................................. 14 M EMBERSHIP CRITERIA FOR RISK POOLS .................................................................................................................... 15 SIZE OF THE RISK POOLS ................................................................................................................................................ 15 SETTING CAPITATION PAYMENTS................................................................................................................................. 16 VARIATIONS IN THE BENEFIT PACKAGE ...................................................................................................................... 18 RETROSPECTIVE RISK SHARING.................................................................................................................................... 19 OVERLAPPING RISK POOLS............................................................................................................................................ 20 PAYMENT SYSTEMS AND RISK...

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