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Public and Private Health Insurance in Germany: The Ignored Risk Selection Problem

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Abstract

While risk selection within the German public health insurance system has received considerable attention, risk selection between public and private health insurers has largely been ignored. This is surprising since – given the institutional structure – risk selection between systems is likely to be more pronounced. We find clear evidence for risk selection in favor of private insurers. While private insurers are unable to select the healthy upon enrollment they manage to dump high risk individuals who then end up in the public system. This gives private insurers an unjustified competitive advantage vis-à-vis public insurer. A risk adjusted compensation would mitigate this advantage.

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Bibliographic Info

Paper provided by Universitaet Augsburg, Institute for Economics in its series Discussion Paper Series with number 312.

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Length: pages
Date of creation: Aug 2010
Date of revision:
Handle: RePEc:aug:augsbe:0312

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Keywords: risk selection; public and private health insurance; risk adjustment;

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  1. Doorslaer, Eddy van & Jones, Andrew M., 2003. "Inequalities in self-reported health: validation of a new approach to measurement," Journal of Health Economics, Elsevier, vol. 22(1), pages 61-87, January.
  2. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
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Cited by:
  1. Bünnings, Christian & Tauchmann, Harald, 2013. "Who opts out of the statutory health insurance? A discrete time hazard model for Germany," IWQW Discussion Paper Series 10/2013, Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Wirtschaftspolitik und Quantitative Wirtschaftsforschung (IWQW).
  2. Kifmann, Mathias & Nell, Martin, 2013. "Fairer Systemwettbewerb zwischen gesetzlicher und privater Krankenversicherung," hche Research Papers 2013/06, Hamburg Center for Health Economics (hche), University of Hamburg.

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