英语翻译Regulated competition in social health insurance:A three

英语翻译
Regulated competition in social health insurance:A three-country comparison
contributions.Conversely,the favourable risks (low-risk patients) will be members of sickness funds with low contributions.This situation is not compatible with the idea of solidarity in social health insurance countries,since in fact it paves the way for risk-related premiums.
Third,preferred risk selection strategies that are highly rational from an individual sickness fund point of view create welfare losses for society.Investments for the identification of favourable risks (e.g.information technology) and investments for the attraction of favourable risks and the deterrence of unfavourable risks (e.g.resources used for developing effective
marketing strategies) do not create any societal gains.Therefore,resources spent on preferred risk selection represent a welfare loss (van de Ven and Ellis,2000).Moreover,preferred risk selection strategies may create an unstable market if some sickness funds refrain from selecting risks.These
funds may be forced to declare bankruptcy owing to adverse selection of risks.This consequence also represents a welfare loss to society.
In order to assess the extent to which incentives for risk selection are neutralized in Germany,the Netherlands and Switzerland,the following questions need to be answered:
• Does the country use health-based risk adjusters for the risk adjustment
mechanism?
Research is unanimous that adjusters based on sex and age (demographic adjusters) will predict actual healthcare expenditures of individuals quite badly (van de Ven and Ellis,2000).If the risk adjustment formulatakes into account information about prior diagnosis and/or prior costs,the
risk adjustment formula predicts actual healthcare expenses of individuals more accurately.Thus,it neutralizes incentives for sickness funds to select risks more effectively.The difference between actuarially predicted expenses and revenue from contributions and the risk adjustment mechanism
is much smaller.
• Does the country have a risk adjustment mechanism that is open-ended?
If the risk adjustment mechanism is not open-ended,it will neutralize incentives for risk selection for a limited period only.After risk adjustment expires,sickness funds will face high incentives for preferred risk selection and high disincentives for improving the efficiency of care for high-risk consumers.
• Does the country have mandatory risk sharing?
There are two reasons for the introduction of mandatory risk sharing.

规管竞争的社会医疗保险：一个三国的比较
捐款.相反,有利于风险（低风险的患者）会成员的疾病保险基金的低贡献.这种情况是不符合的思想团结,社会医疗保险的国家,因为在事实上,它铺平了道路与风险相关的保险费.
第三,偏好风险的战略选择是高度理性的个人疾病保险基金的观点创造的社会福利损失.投资查明有利的风险（例如信息技术）和投资,吸引风险和有利的威慑不利风险（例如,资源用于发展有效
营销策略）不创造任何社会收益.因此,资源用于风险偏好选择一种福利损失（方德万和埃利斯,2000年） .此外,风险偏好选择战略可能造成不稳定的市场,如果某些疾病基金不要选择风险.这些
基金可能被迫宣布破产,由于逆向选择的风险.这一后果也是对社会福利的损失.
为了评估在何种程度上鼓励风险选择是保持中立,德国,荷兰和瑞士,以下问题需要回答：
•是否使用该国的健康为基础的风险算的风险调整
机制?
研究,一致认为算基于性别和年龄（人口算）将预测实际医疗支出的个人相当严重（方德万和埃利斯,2000年） .如果风险调整到有关事先诊断和/或事先费用,
风险调整公式预测实际医疗费用的个人更准确.因此,中和奖励疾病的风险资金,以选择更有效.之间的差异精算预测开支和捐款的收入和风险调整机制
要小得多.
•是否有该国的风险调整机制,是不限成员名额?
如果风险调整机制没有不限成员名额,这将抵消刺激风险选择只能限于有限时间内.风险调整后到期,疾病保险基金将面临高风险偏好的激励选择和高抑制提高其效率的照顾高风险的消费者.
•是否有强制性的国家分担风险?
有两个原因,推行强制风险分担.