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What health plans do people prefer? The trade-off between premium and provider choice

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  • Determann, Domino
  • Lambooij, Mattijs S.
  • de Bekker-Grob, Esther W.
  • Hayen, Arthur P.
  • Varkevisser, Marco
  • Schut, Frederik T.
  • Wit, G. Ardine de

Abstract

Within a healthcare system with managed competition, health insurers are expected to act as prudent buyers of care on behalf of their customers. To fulfil this role adequately, understanding consumer preferences for health plan characteristics is of vital importance. Little is known, however, about these preferences and how they vary across consumers. Using a discrete choice experiment (DCE) we quantified trade-offs between basic health plan characteristics and analysed whether there are differences in preferences according to age, health status and income. We selected four health plan characteristics to be included in the DCE: (i) the level of provider choice and associated level of reimbursement, (ii) the primary focus of provider contracting (price, quality, social responsibility), (iii) the level of service benefits, and (iv) the monthly premium. This selection was based on a literature study, expert interviews and focus group discussions. The DCE consisted of 17 choice sets, each comprising two hypothetical health plan alternatives. A representative sample (n = 533) of the Dutch adult population, based on age, gender and educational level, completed the online questionnaire during the annual open enrolment period for 2015. The final model with four latent classes showed that being able to choose a care provider freely was by far the most decisive characteristic for respondents aged over 45, those with chronic conditions, and those with a gross income over €3000/month. Monthly premium was the most important choice determinant for young, healthy, and lower income respondents. We conclude that it would be very unlikely for half of the sample to opt for health plans with restricted provider choice. However, a premium discount up to €15/month by restricted health plans might motivate especially younger, healthier, and less wealthy consumers to choose these plans.

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  • Determann, Domino & Lambooij, Mattijs S. & de Bekker-Grob, Esther W. & Hayen, Arthur P. & Varkevisser, Marco & Schut, Frederik T. & Wit, G. Ardine de, 2016. "What health plans do people prefer? The trade-off between premium and provider choice," Social Science & Medicine, Elsevier, vol. 165(C), pages 10-18.
  • Handle: RePEc:eee:socmed:v:165:y:2016:i:c:p:10-18
    DOI: 10.1016/j.socscimed.2016.07.022
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    Cited by:

    1. Anne-Fleur Roos & Eddy van Doorslaer & Owen O'Donnell & Erik Schut & Marco Varkevisser, 2018. "Does price competition damage healthcare quality?," Tinbergen Institute Discussion Papers 18-040/V, Tinbergen Institute.
    2. Bes, Romy E. & Curfs, Emile C. & Groenewegen, Peter P. & de Jong, Judith D., 2017. "Selective contracting and channelling patients to preferred providers: A scoping review," Health Policy, Elsevier, vol. 121(5), pages 504-514.
    3. Joachim Marti & John Buckell & Johanna Catherine Maclean & Jody L. Sindelar, 2016. "To ‘Vape’ or Smoke? A Discrete Choice Experiment Among U.S. Adult Smokers," NBER Working Papers 22079, National Bureau of Economic Research, Inc.
    4. Peyron, Christine & Pélissier, Aurore & Béjean, Sophie, 2018. "Preference heterogeneity with respect to whole genome sequencing. A discrete choice experiment among parents of children with rare genetic diseases," Social Science & Medicine, Elsevier, vol. 214(C), pages 125-132.
    5. Liu, Yun & Kong, Qingxia & de Bekker-Grob, Esther W., 2019. "Public preferences for health care facilities in rural China: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 237(C), pages 1-1.
    6. Joachim Marti & John Buckell & Johanna Catherine Maclean & Jody Sindelar, 2019. "To “Vape” Or Smoke? Experimental Evidence On Adult Smokers," Economic Inquiry, Western Economic Association International, vol. 57(1), pages 705-725, January.

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