Designing feasible and effective health plan payments in countries with data availability constraints

Risk equalization schemes, which transfer money to/from insurers that have above/below average risks, are a fundamental tool in regulated health insurance markets in many countries. Risk sharing (the transfer of some responsibility for costs from a plan to the regulator or the overall insurance market), are an additional method of insulating insurers who attract higher-than-average risks. This paper proposes, implements and quantifies incorporating risk sharing within a risk equalization scheme that can be applied in a data-poor context. Using Chile's private health insurance market as case study, we show that modest amount of risk sharing greatly improves fit even in simple demographic-based risk equalization. Expanding the model's formula to include morbidity-based adjustors and risk sharing redirects compensations at insurer level and reduces opportunity to engage in profitable risk selection at the group level. Our emphasis on feasibility may make alternatives proposed attractive to countries facing data-availability constraints.     

A social capital approach of market orientation in public non-profit organizations: The case of blood transfusion centers in Spain

In order to identify the determinants of market (donor) orientation in blood transfusion centers and services (BTCS), this study seeks to analyze whether connectedness and interpersonal trust represent a fundamental basis for interfunctional coordination that leads to market (donor) orientation. An empirical study was carried out with 147 participants from 14 Spanish BTCS. The measurement scales were validated through CFA and the proposed relationship model was tested using SEM. Both interpersonal trust and connectedness that exist among BTCS members foster interfunctional coordination and, ultimately, their donor orientation. Thus, BTCS must emphasize their internal relationship networks, rearranging them in favor of their donor orientation. This paper integrates social capital literature with market orientation literature, and it proposes empirical evidence on the role played by internal social links on interfunctional coordination, which leads to market orientation. This research proposes a reliable and valid measure of blood donor orientation, which could be useful for the future testing of theory and research in the non-profit context. BTCS should adopt an organizational design which allows the introduction of a new managerial paradigm. People in charge of different areas at BTCS must pay particular attention to the climate of trust and the level of connectedness in cross-functional relationships. The negative evolution of blood donation and the results of this research suggest that BTCS need to apply a management model focused on the donor, in order to achieve a sustainable donation system.