IDEAS home Printed from https://ideas.repec.org/a/acb/agenda/v18y2011i2p49-70.html
   My bibliography  Save this article

Removing Duplication in Public/Private Health Insurance in Australia: Opting Out With Risk-adjusted Subsidies?

Author

Listed:
  • Francesco Paolucci
  • James R. G. Butler
  • Wynand P. M. M. van de Ven

Abstract

Australia's existing health-financing arrangements lead to partial duplication in coverage for private health insurance (PHI) holders. The two options to remove duplication are: 1) allowing individuals to 'opt out' from Medicare either (a) by purchasing PHI or (b) by self-insuring via medical savings accounts or other pre- payment arrangements; 2) confining PHI to the coverage of supplementary services. This paper argues in favour of Option 1(a), and argues that from an efficiency perspective PHI should be fully substitutive of Medicare coverage (that is, 'opting out' should be allowed); community rating should be replaced by premium bands; and the 30-40 per cent ad valorem subsidy for PHI should be replaced by ex-ante risk-adjusted subsidies.

Suggested Citation

  • Francesco Paolucci & James R. G. Butler & Wynand P. M. M. van de Ven, 2011. "Removing Duplication in Public/Private Health Insurance in Australia: Opting Out With Risk-adjusted Subsidies?," Agenda - A Journal of Policy Analysis and Reform, Australian National University, College of Business and Economics, School of Economics, vol. 18(2), pages 49-70.
  • Handle: RePEc:acb:agenda:v:18:y:2011:i:2:p:49-70
    as

    Download full text from publisher

    File URL: http://press-files.anu.edu.au/downloads/press/p151621/pdf/ch044.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Paolucci, Francesco & Exter, Andre Den & De Ven, Wynand Van, 2006. "Solidarity in competitive health insurance markets: analysing the relevant EC legal framework," Health Economics, Policy and Law, Cambridge University Press, vol. 1(2), pages 107-126, April.
    2. Wilson, Charles, 1977. "A model of insurance markets with incomplete information," Journal of Economic Theory, Elsevier, vol. 16(2), pages 167-207, December.
    3. H. Brown & Luke Connelly, 2005. "Lifetime Cover in Private Insurance Markets," International Journal of Health Economics and Management, Springer, vol. 5(1), pages 75-88, January.
    4. Mingshan Lu & Elizabeth Savage, 2006. "Do financial incentives for supplementary private health insurance reduce pressure on the public system? Evidence from Australia, CHERE Working Paper 2006/11," Working Papers 2006/11, CHERE, University of Technology, Sydney.
    5. van de Ven, Wynand P. M. M. & van Vliet, Rene C. J. A. & Schut, Frederik T. & van Barneveld, Erik M., 2000. "Access to coverage for high-risks in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted premium subsidies?," Journal of Health Economics, Elsevier, vol. 19(3), pages 311-339, May.
    6. Jane Hall & Richard De Abreu Lourenco & Rosalie Viney, 1999. "Carrots and sticks—the fall and fall of private health insurance in Australia," Health Economics, John Wiley & Sons, Ltd., vol. 8(8), pages 653-660, December.
    7. Paolucci, Francesco & Schut, Erik & Beck, Konstantin & Greãÿ, Stefan & Van De Voorde, Carine & Zmora, Irit, 2007. "Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets," Health Economics, Policy and Law, Cambridge University Press, vol. 2(2), pages 173-192, April.
    8. Cutler, David, 2002. "Equality, Efficiency, and Market Fundamentals: The Dynamics of International Medical Care Reform," Scholarly Articles 2640584, Harvard University Department of Economics.
    9. Rhema Vaithianathan, 2004. "A Critique of the Private Health Insurance Regulations," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 37(3), pages 257-270, September.
    10. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    11. Luke B Connelly & H Shelton Brown, 2006. "Lifetime Subsidies in Australian Private Health Insurance Markets with Community Rating," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 31(4), pages 705-719, October.
    12. David M. Cutler, 2002. "Equality, Efficiency, and Market Fundamentals: The Dynamics of International Medical-Care Reform," Journal of Economic Literature, American Economic Association, vol. 40(3), pages 881-906, September.
    13. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
    14. Armstrong, John & Paolucci, Francesco & van de Ven, Wynand P.M.M., 2010. "Risk equalisation in voluntary health insurance markets," Health Policy, Elsevier, vol. 98(1), pages 1-2, November.
    15. Francesco Paolucci & Amir Shmueli, 2011. "The Introduction of Ex-ante Risk Equalisation in the Australian Private Health Insurance Market: A First Step," Agenda - A Journal of Policy Analysis and Reform, Australian National University, College of Business and Economics, School of Economics, vol. 18(2), pages 71-92.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Francesco Paolucci & Amir Shmueli, 2011. "The Introduction of Ex-ante Risk Equalisation in the Australian Private Health Insurance Market: A First Step," Agenda - A Journal of Policy Analysis and Reform, Australian National University, College of Business and Economics, School of Economics, vol. 18(2), pages 71-92.
    2. Francesco Paolucci & Femmeke Prinsze & Pieter Stam & Wynand Ven, 2009. "The potential premium range of risk-rating in competitive markets for supplementary health insurance," International Journal of Health Economics and Management, Springer, vol. 9(3), pages 243-258, September.
    3. Anne-Fleur Roos & Frederik Schut, 2012. "Spillover effects of supplementary on basic health insurance: evidence from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 51-62, February.
    4. Thomas Buchmueller, 2008. "Community Rating, Entry-Age Rating and Adverse Selection in Private Health Insurance in Australia*," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 33(4), pages 588-609, October.
    5. Damien Eldridge & Catagay Koc & Ilke Onur & Malathi Velamuri, 2011. "The Impact of Private Hospital Insurance on Utilization of Hospital Care in Australia: Evidence from the National Health Survey," Working Papers 2011.01, School of Economics, La Trobe University, revised Jan 2011.
    6. Rutten, Frans & Bleichrodt, Han & Brouwer, Werner & Koopmanschap, Marc & Schut, Erik, 2001. "Handbook of Health Economics," Journal of Health Economics, Elsevier, vol. 20(5), pages 855-879, September.
    7. Barros, Pedro Pita, 2003. "Cream-skimming, incentives for efficiency and payment system," Journal of Health Economics, Elsevier, vol. 22(3), pages 419-443, May.
    8. Belli, Paolo, 2001. "How adverse selection affects the health insurance market," Policy Research Working Paper Series 2574, The World Bank.
    9. Bardey, David & De Donder, Philippe & Mantilla, César, 2019. "How is the trade-off between adverse selection and discrimination risk affected by genetic testing? Theory and experiment," Journal of Health Economics, Elsevier, vol. 68(C).
    10. Gemmo, Irina & Kubitza, Christian & Rothschild, Casey, 2020. "Constrained efficient equilibria in selection markets with continuous types," Journal of Public Economics, Elsevier, vol. 190(C).
    11. Connelly, Luke B. & Paolucci, Francesco & Butler, James R.G. & Collins, Paul, 2010. "Risk equalisation and voluntary health insurance markets: The case of Australia," Health Policy, Elsevier, vol. 98(1), pages 3-14, November.
    12. Peter Zweifel & Friedrich Breyer, 2012. "The Economics of Social Health Insurance," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 12, Edward Elgar Publishing.
    13. David M. Cutler, 2003. "Supplementing Public Insurance Coverage with Private Coverage: Implications for Medical Care Systems," NBER Chapters, in: Labor Markets and Firm Benefit Policies in Japan and the United States, pages 183-204, National Bureau of Economic Research, Inc.
    14. Karen Eggleston & Randall P. Ellis & Mingshan Lu, 2012. "Risk adjustment and prevention," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 45(4), pages 1586-1607, November.
    15. Sherry Glied, 2003. "Health Care Costs: On the Rise Again," Journal of Economic Perspectives, American Economic Association, vol. 17(2), pages 125-148, Spring.
    16. Dosis, Anastasios, 2019. "Optimal ex post risk adjustment in markets with adverse selection," Journal of Mathematical Economics, Elsevier, vol. 85(C), pages 52-59.
    17. Roger Feldman & Carlos Escribano & Laura Pellisé, 1998. "The role of government in health insurance markets with adverse selection," Health Economics, John Wiley & Sons, Ltd., vol. 7(8), pages 659-670, December.
    18. Chernew, Michael E. & Frick, Kevin D., 1999. "The impact of managed care on the existence of equilibrium in health insurance markets," Journal of Health Economics, Elsevier, vol. 18(5), pages 571-590, October.
    19. van de Ven, Wynand P. M. M. & van Vliet, Rene C. J. A. & Schut, Frederik T. & van Barneveld, Erik M., 2000. "Access to coverage for high-risks in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted premium subsidies?," Journal of Health Economics, Elsevier, vol. 19(3), pages 311-339, May.
    20. Michiel Bijlsma & Jan Boone & Gijsbert Zwart, 2014. "Competition leverage: how the demand side affects optimal risk adjustment," RAND Journal of Economics, RAND Corporation, vol. 45(4), pages 792-815, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:acb:agenda:v:18:y:2011:i:2:p:49-70. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/feanuau.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.