International Experience and Implications of Risk Adjustment in Medical Insurance

doi:10.19546/j.issn.1674-3830.2023.1.024

China Health Insurance ›› 2023, Vol. 0 ›› Issue (1) : 117-121. DOI: 10.19546/j.issn.1674-3830.2023.1.024

International（ Region) Comparison

International Experience and Implications of Risk Adjustment in Medical Insurance

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Abstract

To guarantee the consistency of treatment for people covered by different insurance programs is not only an important goal pursued by countries around the world while achieving universal health coverage (UHC), but also a significant principle in the reform of the healthcare security system. This paper focuses on the formation background, application scenarios and operational experience of the health insurance risk adjustment mechanism in four developed countries, namely Germany, Switzerland, the Netherlands and the United States, in order to reveal how risk adjustment mechanism works in the process of achieving the goal of consistency in health care coverage. This paper proposes general idea about constructing China's health insurance risk adjustment mechanism from the perspective of international experience and provides corresponding reference for deepening the reform of health insurance system in China.

Key words

medical insurance / risk adjustment / international experience

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International Experience and Implications of Risk Adjustment in Medical Insurance[J]. China Health Insurance. 2023, 0(1): 117-121 https://doi.org/10.19546/j.issn.1674-3830.2023.1.024

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