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Optionen der Weiterentwicklung des Risikostrukturausgleichs in der GKV

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  • Friedrich Breyer
  • Mathias Kifmann

Abstract

The system of risk equalization payments among German Statutory Sickness Funds is currently under intensive political debate. While some participants claim that the enormous size of the equalization payments are detrimental to effective competition among funds, others argue that there are still funds which engage heavily in risk selection and are thereby able to keep their contribution rates low. In this paper the major options for a modification of the current system are analyzed both theoretically and empirically with respect to their capacity to diminish the spread of contribution rates, while preserving incentives for an efficient delivery of health care services. In particular, we examine the inclusion of additional risk adjusters in the equalization formula and the formation of a high-risk pool. The data suggest that it is indeed possible to improve the formula without diminishing the incentives for efficiency if the risk adjusters "income" and "marital status" are included.

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File URL: http://www.diw.de/documents/publikationen/73/diw_01.c.38592.de/dp236.pdf
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Bibliographic Info

Paper provided by DIW Berlin, German Institute for Economic Research in its series Discussion Papers of DIW Berlin with number 236.

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Length: 63 p.
Date of creation: 2001
Date of revision:
Handle: RePEc:diw:diwwpp:dp236

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References

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  1. Nigel Rice & Peter Smith, 1999. "Approaches to capitation and risk adjustment in health care: an international survey," Working Papers 038cheop, Centre for Health Economics, University of York.
  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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Citations

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Cited by:
  1. Höppner, Karin & Greß, Stefan & Rothgang, Heinz & Wasem, Jürgen & Braun, Bernard & Buitkamp, Martin, 2005. "Grenzen und Dysfunktionalitäten des Kassenwettbewerbs in der GKV: Theorie und Empirie der Risikolektion in Deutschland," Working papers of the ZeS 04/2005, University of Bremen, Centre for Social Policy Research (ZeS).
  2. Udo Schneider & Volker Ulrich & Eberhard Wille, 2008. "Risk Adjustment Systems in Health Insurance Markets in the US, Germany, Netherlands and Switzerland," CESifo DICE Report, Ifo Institute for Economic Research at the University of Munich, vol. 6(3), pages 37-49, October.
  3. Johannes Schwarze & Hanfried H. Andersen, 2001. "Kassenwechsel in der gesetzlichen Krankenversicherung: welche Rolle spielt der Beitragssatz?," Discussion Papers of DIW Berlin 267, DIW Berlin, German Institute for Economic Research.
  4. Thomas Gries & Dirk Langeleh, 2004. "Anreizkompatibilität als zentrales Element eines neu gestalteten Gesundheitsmarktes," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 5(3), pages 293-311, 08.
  5. Knaus, Thomas & Nuscheler, Robert, 2002. "Incomplete risk adjustment and adverse selection in the German public health insurance system," Discussion Papers, Research Unit: Market Processes and Governance FS IV 02-27, Social Science Research Center Berlin (WZB).
  6. Dirk Goepffarth & Klaus-Dirk Henke, 2007. "Finanzierungsreform und Risikostrukturausgleich - Was bleibt vom Ausgleichsverfahren?," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), Justus-Liebig University Giessen, Department of Statistics and Economics, vol. 227(1), pages 27-48, February.
  7. Stefan Fetzer & Bernd Raffelhüschen, 2005. "Zur Wiederbelebung des Generationenvertrags in der gesetzlichen Krankenversicherung: Die Freiburger Agenda," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 6(2), pages 255-274, 05.
  8. Robert Nuscheler & Thomas Knaus, 2005. "Risk selection in the German public health insurance system," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1253-1271.
  9. Göpffarth, Dirk, 2004. "Die Reform des Risikostrukturausgleichs: Eine Zwischenbilanz," Discussion Papers 2004/18, Technische Universität Berlin, School of Economics and Management.
  10. Susanna Kochskämper, 2012. "Reformdebatten in der Krankenversicherung vor dem Hintergrund des europäischen Binnenmarktes," Otto-Wolff-Institut Discussion Paper Series 02/2012, Otto-Wolff-Institut für Wirtschaftsordnung, Köln, Deutschland.
  11. Dieterich, Felix, 2005. "Risikoselektion und Risikoausgleich am Beispiel der gesetzlichen Krankenkassen in Deutschland," Discussion Papers in Economics 718, University of Munich, Department of Economics.
  12. Bettina Becker & Silke Uebelmesser, 2010. "Health Insurance Competition in Germany - The Role of Advertising," Discussion Paper Series 2010_05, Department of Economics, Loughborough University, revised Mar 2010.
  13. Wolfgang Buchholz & Birgit Edener & Markus Grabka & Klaus-Dirk Henke & Monika Huber & Hermann Ribhegge & Andreas Ryll & Hans-Jürgen Wagener & Gert G. Wagner, 2001. "Wettbewerb aller Krankenversicherungen kann Qualität verbessern und Kosten des Gesundheitswesens senken," Discussion Papers of DIW Berlin 247, DIW Berlin, German Institute for Economic Research.

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