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Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets

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  • PAOLUCCI, FRANCESCO
  • SCHUT, ERIK
  • BECK, KONSTANTIN
  • GREß, STEFAN
  • VAN DE VOORDE, CARINE
  • ZMORA, IRIT

Abstract

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

Suggested Citation

  • Paolucci, Francesco & Schut, Erik & Beck, Konstantin & Greß, 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(02), pages 173-192, April.
  • Handle: RePEc:cup:hecopl:v:2:y:2007:i:02:p:173-192_00
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    1. Kaestner, R. & Joyce, T. & Racine, A., 2001. "Medicaid eligibility and the incidence of ambulatory care sensitive hospitalizations for children," Social Science & Medicine, Elsevier, vol. 52(2), pages 305-313, January.
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    Citations

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    Cited by:

    1. Frank, Richard G. & Lamiraud, Karine, 2009. "Choice, price competition and complexity in markets for health insurance," Journal of Economic Behavior & Organization, Elsevier, vol. 71(2), pages 550-562, August.
    2. Mark Stabile & Sarah Thomson, 2014. "The Changing Role of Government in Financing Health Care: An International Perspective," Journal of Economic Literature, American Economic Association, vol. 52(2), pages 480-518, June.
    3. repec:eee:hepoli:v:121:y:2017:i:10:p:1085-1092 is not listed on IDEAS
    4. Omar Paccagnella & Vincenzo Rebba & Guglielmo Weber, 2013. "VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 289-315, March.
    5. Sebastian Gechert, 2010. "Supplementary Private Health Insurance in Selected Countries: Lessons for EU Governments?," CESifo Economic Studies, CESifo, vol. 56(3), pages 444-464, September.
    6. Piet Bakx & Erik Schut & Eddy van Doorslaer, 2013. "Can Risk Adjustment prevent Risk Selection in a Competitive Long-Term Care Insurance Market?," Tinbergen Institute Discussion Papers 13-017/V, Tinbergen Institute.
    7. Thomson, Sarah & Busse, Reinhard & Crivelli, Luca & van de Ven, Wynand & Van de Voorde, Carine, 2013. "Statutory health insurance competition in Europe: A four-country comparison," Health Policy, Elsevier, vol. 109(3), pages 209-225.
    8. 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.
    9. 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.
    10. 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.
    11. Pieter Bakx & Frederik Schut & Eddy Doorslaer, 2015. "Can universal access and competition in long-term care insurance be combined?," International Journal of Health Economics and Management, Springer, vol. 15(2), pages 185-213, June.
    12. Brigitte Dormont & Pierre-Yves Geoffard & Karine Lamiraud, 2009. "The influence of supplementary health insurance on switching behaviour: evidence from Swiss data," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1339-1356.
    13. Radovan Chalupka, 2010. "Improving Risk Adjustment in the Czech Republic," Prague Economic Papers, University of Economics, Prague, vol. 2010(3), pages 236-250.
    14. van de Ven, Wynand P.M.M. & Beck, Konstantin & Buchner, Florian & Schokkaert, Erik & Schut, F.T. (Erik) & Shmueli, Amir & Wasem, Juergen, 2013. "Preconditions for efficiency and affordability in competitive healthcare markets: Are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland?," Health Policy, Elsevier, vol. 109(3), pages 226-245.
    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.
    16. repec:dau:papers:123456789/1623 is not listed on IDEAS
    17. Daniëlle Duijmelinck & Wynand Ven, 2014. "Choice of insurer for basic health insurance restricted by supplementary insurance," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 737-746, September.

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