Please use this identifier to cite or link to this item: https://hdl.handle.net/10419/167493 
Year of Publication: 
2017
Series/Report no.: 
CESifo Working Paper No. 6507
Publisher: 
Center for Economic Studies and ifo Institute (CESifo), Munich
Abstract: 
Many 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.
Subjects: 
health plan payment
risk adjustment
managed competition
diagnostic coding
German Statutory Health Insurance
JEL: 
H51
I10
I13
I18
Document Type: 
Working Paper
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