What Is A Formal Sharing Agreement
One of the practical problems with risk sharing is to assess the acceptable costs that form the basis of risk sharing and to define risk-adjusted premium subsidies. In the Netherlands, there is a very detailed specification of the basic benefit package, combined with a standardized fee schedule, and the promoter closely monitors all health fund expenses and decides which expenses are acceptable and which expenses are not. This will become more complicated as care management and negotiation plans for different price and quality levels are put in place, plus health plans will incorporate the basic coverage indicated in supplementary health insurance (as is the case for HMO in the group`s U.S. Medicare system). The problem of the acceptable cost level is related to the lack of clinical consensus on the treatment of certain conditions. It also refers to the distinction between risk factors type S and N (see section 2.2), i.e. risk factors for which solidarity is desired or unwanted. This distinction seems particularly problematic in Belgium [Schokkaert et al. (1998)]. Data exchange agreements must include access and dissemination provisions. It is not advisable to enter into a data exchange agreement in which data protection information can be disclosed, as non-federal organizations are not subject to the Data Protection Act.
Similarly, the non-federal organization should be advised that federal authorities may be required to disclose information under the BLA. Some analytical characteristics of a mixed system can be easily described, useful for introducing the effectiveness of risk-sharing methods to improve the performance of a health payment system. The most important observation is that a low-proportional sharing of risks can significantly improve the adjustment between payment and costs. To make this concrete, look at the risk adjustment model used for future Payments to Medicare Advantage Plans in the United States (described in Chapter 19: Medicare Advantage: Regulated Competition in the Shadow of a Public Option), which contains approximately 100 variables and decades of development. The R-square statistic, which describes the adjustment of planned spending to actual expenditures at the personal level, is about 0.11. A proportional risk sharing of only 6% combined with a simple lump sum prospective payment, which corresponds to the average of the population without the risk adjustment taking place at all, can achieve the same adjustment at the individual level. In particular, a mixed system in which a health plan is paid 94% of the average population, then 6% of a participant`s actual cost, provides a cost-based adjustment of payments with a square R equivalent of 0.11.8 This level of adaptation can be calculated and applies to all underlying data. In other words, the R-square equivalent of a proportional risk-sharing plan can be calculated without data analysis (see Box 4.4).
Another important emotion that can be mobilized to impose informal agreements is shame. Unlike guilt, shame is caused by public revelation and disapproval and therefore requires the exchange of information about the action. As Barr (2002) has shown, the ability to annoy shame varies from person to person. It probably also varies from culture to culture. Identification with a group plays an important role in shame.