IDEAS home Printed from https://ideas.repec.org/p/zbw/zeswps/042005.html

Grenzen und Dysfunktionalitäten des Kassenwettbewerbs in der GKV: Theorie und Empirie der Risikolektion in Deutschland

Author

Listed:
  • Höppner, Karin
  • Greß, Stefan
  • Rothgang, Heinz
  • Wasem, Jürgen
  • Braun, Bernard
  • Buitkamp, Martin

Abstract

Eine Funktionsbedingung für Kassenwettbewerb ist, dass Risikoselektion unterbunden wird. Denn Gegenstand des Kassenwettbewerbs sollen nicht bestimmte Merkmale von Versicherten sein (z.B. der Gesundheitszustand), vielmehr sollen die Anreize zur Verbesserung der Qualität und Effizienz der medizinischen Versorgung verstärkt werden. In einem wettbewerblichen Krankenversicherungssystem mit Risikoselektion werder die Interessen schlechter Risiken unzureichend berücksichtigt. Risikoselektion in der gesetzlichen Krankenversicherung (GKV) soll durch den Risikostrukturausgleich (RSA) verhindert werden. Seine Ausgestaltung muss bisher als unzureichend bezeichnet werden. Die Versichertenmerkmale Einkommen und Morbidität werder nicht hinreichend ausgeglichen. Theoretisch bestehen für die Krankenkassen also deutliche Anreize, Risikoselektion zu betreiben, was sich in der Empirie durch zahlreiche Beispiele belegen lässt.

Suggested Citation

  • 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).
    • Handle: RePEc:zbw:zeswps:042005
    as

    Download full text from publisher

    File URL: https://www.econstor.eu/bitstream/10419/27121/1/512531021.PDF
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. repec:diw:diwwpp:dp236 is not listed on IDEAS
    2. Wasem, Jürgen & Greß, Stefan & Hessel, Franz, 2003. "Hausarztmodelle in der GKV: Effekte und Perspektiven vor dem Hintergrund nationaler und internationaler Erfahrungen," IBES Diskussionsbeiträge 130, University of Duisburg-Essen, Institute of Business and Economic Studie (IBES).
    3. Paul J. McNulty, 1968. "Economic Theory and the Meaning of Competition," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 82(4), pages 639-656.
    4. George A. Akerlof, 1970. "The Market for "Lemons": Quality Uncertainty and the Market Mechanism," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 84(3), pages 488-500.
    5. 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.
    6. Bode, Ingo, 2002. "Vom Payer zum Player oder: Krankenkassen im Wandel. Der Fall der AOK und ein vergleichender Exkurs nach Frankreich," Duisburger Beiträge zur soziologischen Forschung 4/2002, University of Duisburg-Essen, Institute of Sociology.
    7. repec:diw:diwwpp:dp267 is not listed on IDEAS
    8. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    9. Pauly, Mark V., 1984. "Is cream-skimming a problem for the competitive medical market?," Journal of Health Economics, Elsevier, vol. 3(1), pages 87-95, April.
    10. Michael Spence, 1973. "Job Market Signaling," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 87(3), pages 355-374.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Kick, Markus & Littich, Martina, 2015. "Brand and Reputation as Quality Signals on Regulated Markets," EconStor Preprints 182503, ZBW - Leibniz Information Centre for Economics.
    2. Kick, Markus, 2015. "The Price Premium Induced by Branding: A Health Care Case Study," EconStor Preprints 182504, ZBW - Leibniz Information Centre for Economics.
    3. Bauhoff, Sebastian, 2012. "Do health plans risk-select? An audit study on Germany's Social Health Insurance," Journal of Public Economics, Elsevier, vol. 96(9-10), pages 750-759.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dongyuan Zhan & Amy R. Ward, 2019. "Staffing, Routing, and Payment to Trade off Speed and Quality in Large Service Systems," Operations Research, INFORMS, vol. 67(6), pages 1738-1751, November.
    2. Fan Liang, 2026. "Adverse Selection and Small Business Finances," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 61, August.
    3. Kifmann, Mathias, 2002. "Community rating in health insurance and different benefit packages," Journal of Health Economics, Elsevier, vol. 21(5), pages 719-737, September.
    4. Francois Lantin & Pierre Roy, 2007. "L'impact de la notation financière sur les stratégies de croissance externe," Post-Print halshs-00692570, HAL.
    5. Keane, Michael, 2004. "Modeling Health Insurance Choices in “Competitive” Markets," MPRA Paper 55198, University Library of Munich, Germany.
    6. Fabrice Etilé & Sabrina Teyssier, 2012. "Signaling Corporate Social Responsibility: Third-Party Certification vs. Brands," PSE Working Papers halshs-00736551, HAL.
    7. John Kennes & Aaron Schiff, 2003. "The Value of a Reputation System," Industrial Organization 0301011, University Library of Munich, Germany.
    8. Jacob Glazer & Thomas G. McGuire & Julie Shi, 2016. "Risk Adjustment of Health Plan Payments to Correct Inefficient Plan Choice from Adverse Selection," NBER Chapters, in: Measuring and Modeling Health Care Costs, pages 379-418, National Bureau of Economic Research, Inc.
    9. van de Ven, Wynand P. M. M. & van Vliet, Rene C. J. A. & Schut, Frederik T. & van Barneveld, Erik M., 2000. "Access to coverage for high-risks in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted premium subsidies?," Journal of Health Economics, Elsevier, vol. 19(3), pages 311-339, May.
    10. Joseph E. Stiglitz, 2017. "The Revolution of Information Economics: The Past and the Future," NBER Working Papers 23780, National Bureau of Economic Research, Inc.
    11. Adam Blandin & John H. Boyd & Edward C. Prescott, 2016. "Equilibrium with mutual organizations in adverse selection economies," Economic Theory, Springer;Society for the Advancement of Economic Theory (SAET), vol. 62(1), pages 3-13, June.
    12. Garcia-Villegas, Salomon, 2023. "The amplification effects of adverse selection in mortgage credit supply," Journal of Housing Economics, Elsevier, vol. 62(C).
    13. Puelz, Robert & Snow, Arthur, 1994. "Evidence on Adverse Selection: Equilibrium Signaling and Cross-Subsidization in the Insurance Market," Journal of Political Economy, University of Chicago Press, vol. 102(2), pages 236-257, April.
    14. Ladera, Ivan, 2026. "Las señales no desaparecen, evolucionan: erosión informativa y señalización adaptativa bajo shocks exógenos de costo [Signals Don't Disappear, They Evolve: Informational Erosion and Adaptive Signaling under Exogenous Cost Shocks]," MPRA Paper 130011, University Library of Munich, Germany.
    15. Joshua Henkel, 2022. "Economics & Biology: The whole is something besides the parts – a complementary approach to a bioeconomy," Bremen Papers on Economics & Innovation 2210, University of Bremen, Faculty of Business Studies and Economics.
    16. H. E. Frech & Peter Zweifel, 2017. "Market Socialism and Community Rating in Health Insurance," Comparative Economic Studies, Palgrave Macmillan;Association for Comparative Economic Studies, vol. 59(3), pages 405-427, September.
    17. Frieden, B. Roy & Hawkins, Raymond J., 2010. "Asymmetric information and economics," Physica A: Statistical Mechanics and its Applications, Elsevier, vol. 389(2), pages 287-295.
    18. Batata, Amber, 2004. "The effect of HMOs on fee-for-service health care expenditures: evidence from medicare revisited," Journal of Health Economics, Elsevier, vol. 23(5), pages 951-963, September.
    19. Towne, Bryce Petofi, 2025. "Information Completeness and Incompleteness," SocArXiv gqpsf_v1, Center for Open Science.
    20. repec:eee:labchp:v:2:y:1986:i:c:p:789-848 is not listed on IDEAS
    21. Timothy J. Layton & Randall P. Ellis & Thomas G. McGuire, 2015. "Assessing Incentives for Adverse Selection in Health Plan Payment Systems," NBER Working Papers 21531, National Bureau of Economic Research, Inc.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:zbw:zeswps:042005. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ZBW - Leibniz Information Centre for Economics (email available below). General contact details of provider: https://edirc.repec.org/data/zesbrde.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.