Arbeitspapier
Plan Responses to Diagnosis-Based Payment: Evidence from Germany's Morbidity-Based Risk Adjustment
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.
- Language
-
Englisch
- Bibliographic citation
-
Series: CESifo Working Paper ; No. 6507
- Classification
-
Wirtschaft
National Government Expenditures and Health
Health: General
Health Insurance, Public and Private
Health: Government Policy; Regulation; Public Health
- Subject
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health plan payment
risk adjustment
managed competition
diagnostic coding
German Statutory Health Insurance
- Event
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Geistige Schöpfung
- (who)
-
Bauhoff, Sebastian
Fischer, Lisa
Göpffarth, Dirk
Wuppermann, Amelie C.
- Event
-
Veröffentlichung
- (who)
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Center for Economic Studies and ifo Institute (CESifo)
- (where)
-
Munich
- (when)
-
2017
- Handle
- Last update
-
10.03.2025, 11:45 AM CET
Data provider
ZBW - Deutsche Zentralbibliothek für Wirtschaftswissenschaften - Leibniz-Informationszentrum Wirtschaft. If you have any questions about the object, please contact the data provider.
Object type
- Arbeitspapier
Associated
- Bauhoff, Sebastian
- Fischer, Lisa
- Göpffarth, Dirk
- Wuppermann, Amelie C.
- Center for Economic Studies and ifo Institute (CESifo)
Time of origin
- 2017
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