Richard C. van Kleef

Institute of Health Policy and Management
Erasmus University Rotterdam
PO Box 1738
3000 DR Rotterdam
The Netherlands

Institutional Affiliation: Erasus University

NBER Working Papers and Publications

December 2018Reinsurance, Repayments, and Risk Adjustment in Individual Health Insurance: Germany, The Netherlands and the U.S. Marketplaces
with Thomas G. McGuire, Sonja Schillo: w25374
Reinsurance can complement risk adjustment of health plan payments to improve fit of payments to plan spending at the individual and group level. This paper proposes three improvements in health plan payment systems using reinsurance. First, we base reinsurance payments on spending not accounted for by the risk adjustment system, rather than just high spending. Second, we propose pairing reinsurance for individual-level losses with repayments for individual-level profits. Third, we optimize the weights on the risk adjustors taking account of the presence of reinsurance/repayment. We implement our methodology in data from Germany, The Netherlands and the U.S. Marketplaces, comparing our modified approach to plan payment with risk adjustment as currently practiced in the three settings. ...

Published: Thomas G. McGuire & Sonja Schillo & Richard C. van Kleef, 2020. "Reinsurance, Repayments, and Risk Adjustment in Individual Health Insurance," American Journal of Health Economics, vol 6(1), pages 139-168.

September 2016Deriving Risk Adjustment Payment Weights to Maximize Efficiency of Health Insurance Markets
with Timothy J. Layton, Thomas G. McGuire: w22642
Risk adjustment of payments to health plans is fundamental to regulated competition among private insurers, which serves as the basis of national health policy in many countries. To date, estimation and evaluation of a risk adjustment model has been a two-step process. In a first step, the risk-adjustment payment weights are estimated using statistical techniques, generally ordinary-least squares, to maximize some statistical objective such as the R-squared; then, in a second step, the risk adjustment model is evaluated, usually with simulation methods, but without an explicit framework describing the objective of the model. This paper first develops such a framework and then uses it to replace the two-step “estimate-then-evaluate” approach with a one-step “estimate-to-maximize-the-obje...

Published: Timothy J. Layton & Thomas G. McGuire & Richard C. van Kleef, 2018. "Deriving Risk Adjustment Payment Weights to Maximize Efficiency of Health Insurance Markets," Journal of Health Economics, . citation courtesy of

September 2015Improving Risk Equalization with Constrained Regression
with Thomas McGuire, Rene van Vliet, Wynand van de Ven: w21570
Several countries rely on regulated health plan competition to combine affordability of health plans with incentives for cost containment and quality improvement. Typically, these policies include premium regulation supplemented with risk equalization to compensate health plans for predictable variation in medical spending. An extensive empirical literature shows, however, that even the state-of-the-art risk equalization models undercompensate some risk groups and overcompensate others, leaving systematic incentives for risk selection. A natural approach to reducing under or overcompensation for a group is to include membership in that group as an indicator in the risk equalization model. For several types of indicators, however, inclusion can be problematic or infeasible. This paper intro...

Published: van Kleef, R.C., McGuire, T.G., van Vliet, R.C.J.A. et al. Eur J Health Econ (2017) 18: 1137.

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