ASSESSING RELATIVE HEALTH PLAN RISK WITH THE RAND-36 HEALTH SURVEY

Unbiased risk assessment models base health plan payments on enrollee health care needs. We explored the risk structure of employed adult he alth maintenance organization (HMO) members using the RAND-36 health s urvey. We used multivariate techniques to estimate risk weights on dem ographic and health status factors. The dependent variable was annual real total health plan expense for covered services for the year follo wing the survey. Repeated random-split-sample validation techniques mi nimized outlier influences. Five scales improved prediction over simpl e demographic factors, but demographic factors still were required to achieve unbiased forecasts. Self-reported health status is a useful an d powerful risk measure for adults.