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Addressing Market Segmentation and Incentives for Risk Selection: How Well Does Risk Equalisation in the Irish Private Health Insurance Market Work?

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Listed:
  • Conor Keegan

    (Economic and Social Research Institute, Dublin)

  • Conor Teljeur

    (Health Information and Quality Authority)

  • Brian Turner

    (University College Cork)

  • Steve Thomas

    (Trinity College Dublin)

Abstract

This study assesses the efficacy of Ireland’s recently introduced risk equalisation scheme in its voluntary health insurance market. Robust risk equalisation is especially important in an Irish context given acute risk segmentation and incentives for risk selection that have evolved within the market. Using uniquely acquired VHI data (N=1,235,922) this analysis assesses the predictive efficacy of both current and alternative risk equalisation specifications. Results suggest that the low predictive power of the current risk equalisation design (R2 = 6.8 per cent) is not appropriately correcting for anti-competitive incentives and asymmetries in the market. Improvements to the current design could be achieved through the introduction of diagnosis-based risk adjusters.

Suggested Citation

  • Conor Keegan & Conor Teljeur & Brian Turner & Steve Thomas, 2017. "Addressing Market Segmentation and Incentives for Risk Selection: How Well Does Risk Equalisation in the Irish Private Health Insurance Market Work?," The Economic and Social Review, Economic and Social Studies, vol. 48(1), pages 61-84.
    • Handle: RePEc:eso:journl:v:48:y:2017:i:1:p:61-84
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    1. Buchner, Florian & Goepffarth, Dirk & Wasem, Juergen, 2013. "The new risk adjustment formula in Germany: Implementation and first experiences," Health Policy, Elsevier, vol. 109(3), pages 253-262.
    2. Smith, Samantha & Normand, Charles, 2009. "Analysing equity in health care financing: A flow of funds approach," Social Science & Medicine, Elsevier, vol. 69(3), pages 379-386, August.
    3. Breyer, Friedrich & Bundorf, M. Kate & Pauly, Mark V., 2011. "Health Care Spending Risk, Health Insurance, and Payment to Health Plans," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 691-762, Elsevier.
    4. Turner, Brian & Shinnick, Edward, 2013. "Community rating in the absence of risk equalisation: lessons from the Irish private health insurance market," Health Economics, Policy and Law, Cambridge University Press, vol. 8(2), pages 209-224, April.
    5. Francesca Colombo & Nicole Tapay, 2004. "Private Health Insurance in Ireland: A Case Study," OECD Health Working Papers 10, OECD Publishing.
    6. S. Veen & R. Kleef & W. Ven & R. Vliet, 2015. "Improving the prediction model used in risk equalization: cost and diagnostic information from multiple prior years," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(2), pages 201-218, March.
    7. Armstrong, John & Paolucci, Francesco & van de Ven, Wynand P.M.M., 2010. "Risk equalisation in voluntary health insurance markets," Health Policy, Elsevier, vol. 98(1), pages 1-2, November.
    8. 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.
    9. Wren, Maev-Ann & Connolly, Sheelagh & Cunningham, Nathan, 2015. "An Examination of the Potential Costs of Universal Health Insurance in Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS45, June.
    10. Kiil, Astrid, 2012. "What characterises the privately insured in universal health care systems? A review of the empirical evidence," Health Policy, Elsevier, vol. 106(1), pages 60-75.
    11. Duijmelinck, Daniëlle M.I.D. & Mosca, Ilaria & van de Ven, Wynand P.M.M., 2015. "Switching benefits and costs in competitive health insurance markets: A conceptual framework and empirical evidence from the Netherlands," Health Policy, Elsevier, vol. 119(5), pages 664-671.
    12. Brian Nolan, 2006. "The Interaction of Public and Private Health Insurance: Ireland as a Case Study," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 31(4), pages 633-649, October.
    13. Bevan, Gwyn & van de Ven, Wynand P. M. M., 2010. "Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?1," Health Economics, Policy and Law, Cambridge University Press, vol. 5(3), pages 343-363, July.
    14. Armstrong, John, 2010. "Risk equalisation and voluntary health insurance markets: The case of Ireland," Health Policy, Elsevier, vol. 98(1), pages 15-26, November.
    15. Turner, Brian, 2015. "Unwinding the State subsidisation of private health insurance in Ireland," Health Policy, Elsevier, vol. 119(10), pages 1349-1357.
    16. Van de Ven, Wynand P. M. M., 2011. "Risk adjustment and risk equalization: what needs to be done?," Health Economics, Policy and Law, Cambridge University Press, vol. 6(01), pages 147-156, January.
    17. Corinne Behrend & Florian Buchner & Michael Happich & Rolf Holle & Peter Reitmeir & Jürgen Wasem, 2007. "Risk-adjusted capitation payments: how well do principal inpatient diagnosis-based models work in the German situation? Results from a large data set," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(1), pages 31-39, March.
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    Cited by:

    1. Conor Keegan & Conor Teljeur & Brian Turner & Steve Thomas, 2019. "Switching benefits and costs in the Irish health insurance market: an analysis of consumer surveys," International Journal of Health Economics and Management, Springer, vol. 19(1), pages 15-32, March.
    2. Keegan, Conor, 2020. "The introduction of lifetime community rating in the Irish private health insurance market: Effects on coverage and plan choice," Social Science & Medicine, Elsevier, vol. 255(C).

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