(1) A popular term for the practice by insurers of selling policies to those who do not need them, then dropping those who are insured when they do need the policies (2) A highly colloquial term for the acceptance of patients based solely on their ability to pay—i.e., with insurance or cash—while turning away the indigent or poor
They may also be provider driven, either resulting from cream skimming (i.
Cream skimming is only possible if patient outcomes that are publicly reported are not perfectly risk adjusted or if providers have superior information about patient risk than the risk adjustment used in public reporting.
He deprecates claims made by, among others, the Heritage Foundation, the Education Trust, KIPP Academies, Abigail and Stephan Thernstrom, and Jaime Escalante's biographers, insisting that the achievements don't amount to much or couldn't be replicated or that the schools engage in cream skimming.
We find in our survey that most of the evidence on the effects of performance systems relates to their failure to motivate behavior in the direction of increasing the mean impact of program participation, and their success at inducing cream skimming and strategic responses on the part of program operators.
To address the problems of adverse selection and cream skimming, some payers have been experimenting with various statistical approaches to "risk adjustment," with the goal being to level the proverbial "playing field.
This seems to suggest that having the additional diagnosis risk cells enables sickness funds to obtain higher profits from cream skimming relative to profits from persons grouped only by demographic variables.