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Optionen der Weiterentwicklung des Risikostrukturausgleichs in der GKV

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  • Friedrich Breyer
  • Mathias Kifmann

Abstract

The system of risk equalization payments among German Statutory Sickness Funds is currently under intensive political debate. While some participants claim that the enormous size of the equalization payments are detrimental to effective competition among funds, others argue that there are still funds which engage heavily in risk selection and are thereby able to keep their contribution rates low. In this paper the major options for a modification of the current system are analyzed both theoretically and empirically with respect to their capacity to diminish the spread of contribution rates, while preserving incentives for an efficient delivery of health care services. In particular, we examine the inclusion of additional risk adjusters in the equalization formula and the formation of a high-risk pool. The data suggest that it is indeed possible to improve the formula without diminishing the incentives for efficiency if the risk adjusters "income" and "marital status" are included.

Suggested Citation

  • Friedrich Breyer & Mathias Kifmann, 2001. "Optionen der Weiterentwicklung des Risikostrukturausgleichs in der GKV," Discussion Papers of DIW Berlin 236, DIW Berlin, German Institute for Economic Research.
    • Handle: RePEc:diw:diwwpp:dp236
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    1. 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.
    2. Nigel Rice & Peter Smith, 1999. "Approaches to capitation and risk adjustment in health care: an international survey," Working Papers 038cheop, Centre for Health Economics, University of York.
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    Cited by:

    1. Pilny, Adam & Wübker, Ansgar & Ziebarth, Nicolas R., 2017. "Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany," Journal of Health Economics, Elsevier, vol. 56(C), pages 330-351.
    2. Göpffarth, Dirk, 2004. "Die Reform des Risikostrukturausgleichs: Eine Zwischenbilanz," Discussion Papers 2004/18, Technische Universität Berlin, School of Economics and Management.
    3. Thomas Gries & Dirk Langeleh, 2004. "Anreizkompatibilität als zentrales Element eines neu gestalteten Gesundheitsmarktes," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 5(3), pages 293-311, August.
    4. Höppner, Karin & Greß, Stefan & Rothgang, Heinz & Wasem, Jürgen & Braun, Bernard & Buitkamp, Martin, 2005. "Grenzen und Dysfunktionalitäten des Kassenwettbewerbs in der GKV: Theorie und Empirie der Risikolektion in Deutschland," Working papers of the ZeS 04/2005, University of Bremen, Centre for Social Policy Research (ZeS).
    5. Udo Schneider & Volker Ulrich & Eberhard Wille, 2008. "Risk Adjustment Systems in Health Insurance Markets in the US, Germany, Netherlands and Switzerland," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 6(03), pages 37-49, October.
    6. Dieterich, Felix, 2005. "Risikoselektion und Risikoausgleich am Beispiel der gesetzlichen Krankenkassen in Deutschland," Discussion Papers in Economics 718, University of Munich, Department of Economics.
    7. Knaus, Thomas & Nuscheler, Robert, 2002. "Incomplete risk adjustment and adverse selection in the German public health insurance system [Unvollständiger Risikostrukturausgleich und Adverse Selektion in der Gesetzlichen Krankenversicherung ," Discussion Papers, Research Unit: Market Processes and Governance FS IV 02-27, WZB Berlin Social Science Center.
    8. Bettina Becker & Silke Uebelmesser, 2010. "Health Insurance Competition in Germany - the Role of Advertising," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 130(2), pages 169-194.
    9. Göpffarth Dirk & Henke Klaus-Dirk, 2007. "Finanzierungsreform und Risikostrukturausgleich – Was bleibt vom Ausgleichsverfahren? / Health Care Finance Reform in Germany – Effects on the Risk Adjustment Scheme," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), De Gruyter, vol. 227(1), pages 27-48, February.
    10. Robert Nuscheler & Thomas Knaus, 2005. "Risk selection in the German public health insurance system," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1253-1271, December.
    11. repec:jns:jbstat:v:227:y:2007:i:1:p:27-48 is not listed on IDEAS
    12. repec:ces:ifodic:v:6:y:2008:i:3:p:14567234 is not listed on IDEAS
    13. Susanna Kochskämper, 2012. "Reformdebatten in der Krankenversicherung vor dem Hintergrund des europäischen Binnenmarktes," Otto-Wolff-Institut Discussion Paper Series 02/2012, Otto-Wolff-Institut für Wirtschaftsordnung, Köln, Deutschland.
    14. Wolfgang Buchholz & Birgit Edener & Markus Grabka & Klaus-Dirk Henke & Monika Huber & Hermann Ribhegge & Andreas Ryll & Hans-Jürgen Wagener & Gert G. Wagner, 2001. "Wettbewerb aller Krankenversicherungen kann Qualität verbessern und Kosten des Gesundheitswesens senken," Discussion Papers of DIW Berlin 247, DIW Berlin, German Institute for Economic Research.
    15. Johannes Schwarze & Hanfried H. Andersen, 2001. "Kassenwechsel in der gesetzlichen Krankenversicherung: welche Rolle spielt der Beitragssatz?," Discussion Papers of DIW Berlin 267, DIW Berlin, German Institute for Economic Research.
    16. Stefan Fetzer & Bernd Raffelhüschen, 2005. "Zur Wiederbelebung des Generationenvertrags in der gesetzlichen Krankenversicherung: Die Freiburger Agenda," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 6(2), pages 255-274, May.
    17. Udo Schneider & Volker Ulrich & Eberhard Wille, 2008. "Risk Adjustment Systems in Health Insurance Markets in the US, Germany, Netherlands and Switzerland," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 6(3), pages 37-49, October.

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    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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