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Reimbursing insurance carriers: the case of 'MUFACE' in the Spanish health care system.

This article aims at contributing to the analysis of financial incentives in managed competition, on the basis of the literature on procurement and regulation under incomplete information. More specifically, we focus on MUFACE, the publicly funded health care system for Spanish civil servants and dependants. MUFACE makes up an internal market, where competing public and private insurers are reimbursed a flat capitation payment. Some of our results are that theoretically, both pre-contractual (adverse) selection of insurers contracted by MUFACE, and post-contractual risk selection of enrollees undertaken by insurers, should occur under flat capitation.

Capitation Fee↗
PubMed1996

[The Swiss health insurance carriers in managed care].

The Swiss health care system is currently undergoing radical changes. The balance of power is clearly shifting from the service-providers to the health insurers. Excessive patient demands combined with proliferation of medically unnecessary treatment have led to an inflation of cost equivalent to several billion Swiss francs. Managed Care is a new instrument that enables the insurers to influence patient behavior and, hence, the services offered in an integrated fashion. The key factors necessary for the success of this process are: Clear and timely information with the insured Product design based on precise segmentation Cost effective service-purchasing based on insured requirements Use of insurer-owned service providers to encourage competition The success of Managed Care in Switzerland will largely depend on the readiness of health care stake-holders to adapt, learn, and cooperate in a constructive, professional, and open-minded framework.

Cost Control↗