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Supplementary Private Health Insurance in Selected Countries: Lessons for EU Governments?

  • Sebastian Gechert

A famous idea to maintain affordable health expenditures is to cut back statutory health insurance (SHI) to a basic insurance and to introduce supplementary private health insurance (PHI), permitted to cover the remaining benefits and to apply managed care mechanisms. The measure is supposed to lower public health expenditures and to enhance cost efficiency and quality of service. To test these reasonings, the paper draws empirical evidence from the health systems of Australia, Canada and Switzerland. PHI fails to meet the claims in these countries, since it performs worse than SHI concerning cost development and cannot be expected to improve quality. Cream skimming and adverse selection arise instead. Therefore, regulations and incentives are necessary, but they might counteract the aim of lowering public health expenditures.

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Paper provided by CESifo Group Munich in its series CESifo Working Paper Series with number 2739.

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Date of creation: 2009
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Handle: RePEc:ces:ceswps:_2739
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  1. Stefan Greß & Maral Manouguian & Jürgen Wasem, 2007. "Health Insurance Reform in the Netherlands," CESifo DICE Report, Ifo Institute for Economic Research at the University of Munich, vol. 5(1), pages 63-67, 05.
  2. Glied, Sherry, 2000. "Managed care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 13, pages 707-753 Elsevier.
  3. 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.
  4. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
  5. Beck, Konstantin & Spycher, Stefan & Holly, Alberto & Gardiol, Lucien, 2003. "Risk adjustment in Switzerland," Health Policy, Elsevier, vol. 65(1), pages 63-74, July.
  6. Newhouse, Joseph P., 1982. "Is competition the answer?," Journal of Health Economics, Elsevier, vol. 1(1), pages 109-116, May.
  7. Dormont, Brigitte & Geoffard, Pierre-Yves & Lamiraud, Karine, 2009. "The influence of supplementary health insurance on switching behaviour : evidence from Swiss data," Economics Papers from University Paris Dauphine 123456789/1623, Paris Dauphine University.
  8. Barr, Nicholas, 1992. "Economic Theory and the Welfare State: A Survey and Interpretation," Journal of Economic Literature, American Economic Association, vol. 30(2), pages 741-803, June.
  9. Dana P. Goldman, 1995. "Managed Care as a Public Cost-Containment Mechanism," RAND Journal of Economics, The RAND Corporation, vol. 26(2), pages 277-295, Summer.
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