@article {514906,
	title = {Plan Responses to Diagnosis-Based Payment: Evidence from Germany{\textquoteright}s Morbidity-Based Risk Adjustment},
	journal = {Journal of Health Economics},
	volume = {56},
	year = {2017},
	pages = {397-413},
	abstract = {
	Many competitive health insurance markets adjust payments to participating health plans according to their enrollees{\textquoteright} risk {\textendash} including based on diagnostic information.\&nbsp; 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 {\textquotedblleft}validated{\textquotedblright} diagnoses by providers.\&nbsp; Using the regulator{\textquoteright}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.\&nbsp; 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.\&nbsp; This increase appears to originate from both a shift from not-validated toward validated diagnoses and an increase in the number of such diagnoses. \&nbsp;Overall, our results indicate that plans were successful in influencing physicians{\textquoteright} coding practices in a way that could lead to higher payments.



	Also available as CESIfo Working Paper 6507

},
	url = {https://www.sciencedirect.com/science/article/abs/pii/S016762961730228X},
	author = {Bauhoff, Sebastian and G{\"o}pffarth, Dirk and Fischer, Lisa and Wuppermann, Amelie C.}
}
