Modest risk-sharing significantly reduces health plans’ incentives for service distortion

Shuli Brammli-Greenberg, Jacob Glazer, Ruth Waitzberg

Research output: Contribution to journalArticlepeer-review


Public payers often use payment mechanisms as a way to improve the efficiency of the healthcare system. One source of inefficiency is service distortion (SD) in which health plans over/underprovide services in order to affect the mix of their enrollees. Using Israeli data, we apply a new measure of SD to show that a mixed payment scheme, with a modest level of cost-sharing, yields a significant improvement over a pure risk-adjustment scheme. This observation implies that even though mixed systems induce overprovision of some services, their benefits far outweigh their costs.

Original languageEnglish
Pages (from-to)1359-1374
Number of pages16
JournalEuropean Journal of Health Economics
Issue number9
StatePublished - 1 Dec 2019
Externally publishedYes

Bibliographical note

Funding Information:
An earlier version of this paper was presented at the Risk-Adjustment Network Workshop held in October 2016 in Berlin, Germany. The authors are especially grateful to Konstantin Beck, Randall Ellis, Timothy Layton, Thomas McGuire, Amir Shmueli, Wynand Van de Ven, Richard Van Kleef, and other participants in the workshop for their helpful comments and advice. The authors are also grateful to Glied Sherry, Altman Stuart, Freed Gary and Wittenberg Raphael for their constructive suggestions. This study was funded by a Grant provided by the Israel National Institute for Health Policy Research (Grant number 2012/37).

Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.


  • Adverse selection
  • Capitation
  • Managed care
  • Managed competition
  • Payment mechanisms
  • Risk-adjustment
  • Risk-sharing
  • Service distortion

ASJC Scopus subject areas

  • Economics, Econometrics and Finance (miscellaneous)
  • Health Policy


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