Health care costs during the last 12 months of life in Israel: estimation and implications for risk-adjustment.

Accumulating research shows that decedents' costs are high, they increase towards death, and they comprise a large proportion of total lifetime costs. The objectives of this paper are (i) to examine the Israeli pattern of medical care cost during the 12 months prior to death by gender, age, and chronic conditions, and (ii) to examine the implications of the results for the Israeli risk adjustment scheme. For the first objective, we used 12 month follow-up data on a cohort of decedents.

Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets.

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland.

Risk adjustment and risk selection in Europe: 6 years later.

In this paper we analyse the developments concerning risk adjustment and risk selection in Belgium, Germany, Israel, the Netherlands and Switzerland in the period 2000-2006. Since 2000 two major trends can be observed. On the one hand the risk adjustment systems have been improved, for example, by adding relevant health-based risk adjusters.

Risk adjustment and risk sharing: the Israeli experience.

Israel, like several other countries, introduced a national risk adjusted capitation system during the 1990s. However, the Israeli move was drastic, implementing from the beginning a fully prospective risk adjustment scheme based on age, supplemented by a 100% five condition-specific risk sharing. That scheme, together with open enrollment (periodic switching options), was intended to transform an unregulated competitive health insurance market, characterized by adverse selection and preferred risk selection, into managed competition assuring quality of care, efficiency and fairness.