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Hybrid risk adjustment for pharmaceutical benefits

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Abstract

This paper analyses the application of hybrid risk adjustment versus either prospective or concurrent risk adjustment formulae in the context of funding pharmaceutical benefits for the population of an integrated healthcare delivery organisation in Catalonia during years 2002 and 2003. We apply a mixed formula and find that, compared to prospective only models, a hybrid risk adjustment model increases incentives for efficiency in the provision for low risk individuals in health organisations, not only as a whole but also within each internal department, by reducing within-group variation of drug expenditures.

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Acknowledgements

This research was supported by an unrestricted educational grant awarded jointly to the Universities Carlos III de Madrid and Pompeu Fabra de Barcelona by The Merck Foundation, the philanthropic arm of Merck Co. Inc., White House Station, New Jersey, USA. The authors also thank support from the project 128/01/2004 funded by Catalan Agency for Health Technology Assessment (Agència d'Avaluació de Tecnologia i Recerca Mèdiques de Catalunya-AATRM) and Fondo de Investigación Sanitaria (FIS) PI06/90638. An earlier version of this work has been published as working paper number 399 at Fundación de las Cajas de Ahorros (FUNCAS). We are grateful to Jordi Coderch and Jordi Calsina from Serveis de Salut Integrats del Baix Empordà for their support with the data and their comments, and to Randy Ellis and Pedro Pita for their helpful comments. Remaining errors are the authors’ responsibility.

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Authors and Affiliations

  1. Departamento de Economía Aplicada II, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223, Madrid, Spain

    Manuel García-Goñi

  2. Centre de Recerca en Economia i Salut, Departament d’Economia i Empresa, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain

    Pere Ibern

  3. Serveis de Salut Integrats Baix Empordà, Departament Avaluacio Informacio i Recerca, Hospital de Palamós, Hospital, 36, Palamós, 17230, Girona, Spain

    José María Inoriza

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  1. Manuel García-Goñi
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  2. Pere Ibern
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  3. José María Inoriza
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Correspondence to Manuel García-Goñi.

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García-Goñi, M., Ibern, P. & Inoriza, J.M. Hybrid risk adjustment for pharmaceutical benefits. Eur J Health Econ 10, 299–308 (2009). https://doi.org/10.1007/s10198-008-0133-2

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  • DOI: https://doi.org/10.1007/s10198-008-0133-2

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