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  1. #51
    Minister of Propagandhi ajblaise's Avatar
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    Quote Originally Posted by Lateralus View Post
    I've listened to a lot of debate on this issue (on CSPAN radio) and I have yet to hear any politician mention anti-trust exemptions. It's possible that it has been mentioned and I missed it.
    House Votes To Repeal Antitrust Exemption For Health Insurers

  2. #52
    pathwise dependent FDG's Avatar
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    Quote Originally Posted by Halla74 View Post
    (1) Similar demographic traits in high density across a nations people?

    OR

    (2) Similar political beliefs in high density across a nations people?

    If (1) then that only works for a health care system if the life cycle of the people of the given demographic all adhere closely to a similar and predictable pattern of health related events that make it easier to manage the chronic and or expected high-cost conditions assumed to occur as the aging process moves forward.

    In the U.S., I worked on a Medicaid Reform project that utilized risk adjusted rates for the HMOs that participated in the pilot project. There are two models of rsik adjustment used in the U.S. for risk adjusting pre-paid (capitated) rates: (a) CDPS (Chronic Disability Payment System, using historical physician and hospital claims) and (b) Medicaid Rx (Pharmacy claim analysis identifies high cost ailments via historical claims analysis). At the time the project was implementing here in Florida, the base of people used to assign an individual risk score to each enrollee was from other states (California, Georgia, and Ohio I think).

    Management asked the actuaries from Mercer if there was an issue using historical risk score assumptions from citizens of other states as the base of the first year of our project. The actuaries said "No. In high enough numbers people are people." Ultimately our claims were added to the risk adjustment base, but homogeneity was not an issue for us or other states using that model, as having an extremely heterogenous base of people seemed to level unnatural spikes in ailments incurred by certain groups of people, and thus normalized the weights that affected plan payment.
    ---------------
    Umm. That's a good point actually. I didn't thought about the issue that way. My thinking was more on the line: given that certain states have a different distribution of, say, wealth and income and ethnicity, there will be places where the average of a given disease is higher (say, Louisiana has the highest % of obese people, thus I suppose the rate of cardiovascular disease is higher). However, I can also see how a large number of people can be seen as a group of IID variables and thus the effects cancel out. In that case yeah the objection about lack of homogeneity would be invalid.
    ENTj 7-3-8 sx/sp

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