Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice
McGuire acknowledges support from the Linda and John Arnold Foundation. This collaborative project was inspired by the Risk Adjustment Network (RAN) members who contributed as chapter authors and commenters. Sarah
Stone devoted part of her Summer 2017 to helping edit the chapters when they were arriving fast and furious. We are grateful to her for skilled help at a critical time. Most gratitude is due to our colleagues from around the world
who took the time to assemble such an authoritative set of chapters, and to put up with our repeated calls for revisions. Finally, the editors thank Elsevier’s Susan Ikeda for her guidance and assistance throughout the logistically
complex writing and production process.
In many countries public policy towards health insurance is guided by principles of regulated (or managed) competition. This introductory chapter gives an overview of the intellectual roots of regulated competition and shows how elements of this concept are put into practice in the United States, Europe, Asia, Australia, and Latin America. While there is considerable heterogeneity in the details of the regulations in these markets, there are also many commonalities. In each of these markets, health plan payment serves as a cornerstone for simultaneously achieving efficiency goals and objectives related to fairness. This chapter gives a flavor of the diversity of payment systems and the tradeoffs involved. We conclude by explaining how we see the volume as contributing to policy and research on regulated competition and health plan payment.