• J Health Econ · Dec 2017

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

    • Sebastian Bauhoff, Lisa Fischer, Dirk Göpffarth, and Amelie C Wuppermann.
    • Center for Global Development, 2055 L Street NW, Washington, DC, USA. Electronic address: sbauhoff@cgdev.org.
    • J Health Econ. 2017 Dec 1; 56: 397-413.

    AbstractMany 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.Copyright © 2017 Elsevier B.V. All rights reserved.

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