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 US Marketplaces, comparing our modified approach to plan payment with risk adjustment as currently practiced in the three settings. The combination of the three improvements yields very substantial improvements in the individual-level fit of payments to plan spending in all three countries.

中文翻译：

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个人健康保险中的再保险，还款和风险调整：德国，荷兰和美国市场

再保险可以补充对健康计划付款的风险调整，以提高付款的适合性，以在个人和团体级别计划支出。本文提出了使用再保险的医疗计划支付系统的三项改进。首先，我们将再保险付款基于风险调整系统未计入的支出，而不仅仅是高支出。第二，我们建议将个人损失的再保险与个人收益的还款配对。第三，考虑到再保险/还款的存在，我们优化了风险调节器的权重。我们在来自德国，荷兰和美国市场的数据中实施了我们的方法，并比较了目前在这三种情况下实践的改进的计划付款方式和风险调整。