Available in 2021
Course code



10 units


6000 level

Course handbook


Health Plan Design and Payments provides an overview of the practice of health insurance and financing in advanced health systems and healthcare systems in transition. The course is a comprehensive journey through a crucial element of healthcare systems, which pertains to the complexities of health insurance and financing of health economics: health plan design and payments. Students will gain knowledge in the regulatory frameworks and institutional designs of risk sharing, risk adjustment, premium regulation, and payments schemes from both a conceptual and applied perspective.

Availability2021 Course Timetables


  • Trimester 2 - 2021

Newcastle City Precinct

  • Trimester 2 - 2021

Learning outcomes

On successful completion of the course students will be able to:

1. Demonstrate an understanding of the key conceptual frameworks adopted in health plan design and payment schemes including the options available from regulatory and institutional perspectives.

2. Track and delineate the historical development and evolution of regulation in health plan design and payment.

3. Describe and understand risk sharing, risk adjustment, and incentive mechanisms.

4. Critically compare and assess difference between prospective and retrospective risk adjustment, pay-for-performance and activity based/fixed funding.

5. Critically assess the effects of the regulatory tools on the objectives of the health system and universal health coverage.

6. Identify the advantages and limitations of the in-place regulatory tools in different regulated health systems.

7. Design an evaluation framework for the health plan payment.


The content in this course has five modules:

1.    Ongoing issues in regulated competition in health insurance markets.

2.    Health plan design and payments: the role of regulatory and institutional frameworks.

3.    Premium regulation, risk sharing and risk adjustment for health plan payment.

4.    Evaluating the performance of health plan design and payment systems.

5.    Health plan design and payment systems worldwide: lessons and insights.

Assessment items

Essay: Problem Set Essay

Essay: Evaluation Essay

Presentation: Research Report and Presentation

Contact hours

Newcastle City Precinct and Online

Online Activity

Online 36 hour(s) per Term Full Term starting in week 1

online equivalent of 36 hrs face to face


Face to Face On Campus 36 hour(s) per Term Full Term starting in week 1

Face to face 36 hours per term or online equivalent.

The University of Newcastle acknowledges the traditional custodians of the lands within our footprint areas: Awabakal, Darkinjung, Biripai, Worimi, Wonnarua, and Eora Nations. We also pay respect to the wisdom of our Elders past and present.