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Auftrag und Grenzen der Sozialen Krankenversicherung

  • Peter Zweifel
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    This contribution seeks to answer two questions, (1) What are the reasons for a demand for social health insurance (SHI)?, and (2) What are the limits to the growth of SHI? A review of the reasons for the existence of SHI reveals that while economists have emphasized the possible contribution of SHI to efficiency, the available evidence points to public choice reasons, which also seem to explain better the growth of SHI. Indeed, since private insurance redistributes as well (albeit governed by chance), it is tempting for politicians to use SHI for systematic redistribution (the extent of which cannot easily be detected by net payers). Turning to the supply of SHI, two dimensions are studied in some detail, viz. efforts at product innovation and at risk selection. Competing suppliers of SHI, while hampered by risk adjustment which sanctions innovators for attracting the young, are predicted to invest in innovation. A monopolistic public SHI scheme, by way of contrast, does not need to select risks and, on the other hand, it is predicted to refrain from product innovation. This is but one limit to the growth of SHI; the ultimate one is citizens' lack of willingness to pay for its continuing expansion, about which some evidence for the case of Switzerland is presented. Copyright Verein für Socialpolitik und Blackwell Publishers Ltd, 2006

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    Article provided by Verein für Socialpolitik in its journal Perspektiven der Wirtschaftspolitik.

    Volume (Year): 7 (2006)
    Issue (Month): s1 (05)
    Pages: 5-26

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    Handle: RePEc:bla:perwir:v:7:y:2006:i:s1:p:5-26
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    3. HINDRIKS, Jean & DE DONDER, Philippe, 2001. "The politics of redistributive social insurance," CORE Discussion Papers 2001054, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
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    15. 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.
    16. van Dalen, Hendrik P & Swank, Otto H, 1996. " Government Spending Cycles: Ideological or Opportunistic?," Public Choice, Springer, vol. 89(1-2), pages 183-200, October.
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    19. Pauly, Mark V, 1970. "Efficiency in the Provision of Consumption Subsidies," Kyklos, Wiley Blackwell, vol. 23(1), pages 33-57.
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