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Fine Tuning of Health Insurance Regulation: Unhealthy Consequences for an Individual Insurer

Author

Listed:
  • Johannes Schoder

    (Socioeconomic Institute, University of ZurichAuthor-Name: Michele Sennhauser)

  • Michele Sennhauser

    (Socioeconomic Institute, University of Zurich)

  • Peter Zweifel

    (Socioeconomic Institute, University of Zurich)

Abstract

This paper sheds light on some unexpected consequences of health insurance regulation that may pose a big challenge to insurers� risk management. Because mandated uniform contributions to health insurance trigger risk selection efforts risk adjustment (RA) schemes become necessary. A good deal of research into the optimal RA formula has been performed (Ellis and Van de Ven [2000]). A recent proposal has been to add �Hospitalization exceeding three days during the previous year� as an indicator of high risk (Beck et al. [2006]). Applying the new formula to an individual Swiss health insurer, its payments into the RA scheme are postdicted to explode, reaching up to 13 percent of premium income. Its mistake had been to successfully implement Managed Care, resulting in low rates of hospitalization. The predicted risk management response is to extend hospital stays beyond three days, contrary to stated policy objectives also of the United States.

Suggested Citation

  • Johannes Schoder & Michele Sennhauser & Peter Zweifel, 2009. "Fine Tuning of Health Insurance Regulation: Unhealthy Consequences for an Individual Insurer," SOI - Working Papers 0916, Socioeconomic Institute - University of Zurich.
    • Handle: RePEc:soz:wpaper:0916
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    File URL: https://www.econ.uzh.ch/apps/workingpapers/wp/wp0916.pdf
    File Function: first version, 2009
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    More about this item

    Keywords

    Health insurance; regulation; risk adjustment; risk management;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L51 - Industrial Organization - - Regulation and Industrial Policy - - - Economics of Regulation
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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