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How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence

If consumers have a choice of health plan, risk selection is often a serious problem (e.g., as in Germany, Israel, the Netherlands, the United States of America, and Switzerland). Risk selection may threaten the quality of care for chronically ill people, and may reduce the affordability and efficie...

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Autores principales: van de Ven, Wynand P. M. M., van Vliet, René C. J. A., van Kleef, Richard C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313580/
https://www.ncbi.nlm.nih.gov/pubmed/26837411
http://dx.doi.org/10.1007/s10198-016-0764-7
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author van de Ven, Wynand P. M. M.
van Vliet, René C. J. A.
van Kleef, Richard C.
author_facet van de Ven, Wynand P. M. M.
van Vliet, René C. J. A.
van Kleef, Richard C.
author_sort van de Ven, Wynand P. M. M.
collection PubMed
description If consumers have a choice of health plan, risk selection is often a serious problem (e.g., as in Germany, Israel, the Netherlands, the United States of America, and Switzerland). Risk selection may threaten the quality of care for chronically ill people, and may reduce the affordability and efficiency of healthcare. Therefore, an important question is: how can the regulator show evidence of (no) risk selection? Although this seems easy, showing such evidence is not straightforward. The novelty of this paper is two-fold. First, we provide a conceptual framework for showing evidence of risk selection in competitive health insurance markets. It is not easy to disentangle risk selection and the insurers’ efficiency. We suggest two methods to measure risk selection that are not biased by the insurers’ efficiency. Because these measures underestimate the true risk selection, we also provide a list of signals of selection that can be measured and that, in particular in combination, can show evidence of risk selection. It is impossible to show the absence of risk selection. Second, we empirically measure risk selection among the switchers, taking into account the insurers’ efficiency. Based on 2-year administrative data on healthcare expenses and risk characteristics of nearly all individuals with basic health insurance in the Netherlands (N > 16 million) we find significant risk selection for most health insurers. This is the first publication of hard empirical evidence of risk selection in the Dutch health insurance market.
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spelling pubmed-53135802017-03-01 How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence van de Ven, Wynand P. M. M. van Vliet, René C. J. A. van Kleef, Richard C. Eur J Health Econ Original Paper If consumers have a choice of health plan, risk selection is often a serious problem (e.g., as in Germany, Israel, the Netherlands, the United States of America, and Switzerland). Risk selection may threaten the quality of care for chronically ill people, and may reduce the affordability and efficiency of healthcare. Therefore, an important question is: how can the regulator show evidence of (no) risk selection? Although this seems easy, showing such evidence is not straightforward. The novelty of this paper is two-fold. First, we provide a conceptual framework for showing evidence of risk selection in competitive health insurance markets. It is not easy to disentangle risk selection and the insurers’ efficiency. We suggest two methods to measure risk selection that are not biased by the insurers’ efficiency. Because these measures underestimate the true risk selection, we also provide a list of signals of selection that can be measured and that, in particular in combination, can show evidence of risk selection. It is impossible to show the absence of risk selection. Second, we empirically measure risk selection among the switchers, taking into account the insurers’ efficiency. Based on 2-year administrative data on healthcare expenses and risk characteristics of nearly all individuals with basic health insurance in the Netherlands (N > 16 million) we find significant risk selection for most health insurers. This is the first publication of hard empirical evidence of risk selection in the Dutch health insurance market. Springer Berlin Heidelberg 2016-02-02 2017 /pmc/articles/PMC5313580/ /pubmed/26837411 http://dx.doi.org/10.1007/s10198-016-0764-7 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Paper
van de Ven, Wynand P. M. M.
van Vliet, René C. J. A.
van Kleef, Richard C.
How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence
title How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence
title_full How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence
title_fullStr How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence
title_full_unstemmed How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence
title_short How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence
title_sort how can the regulator show evidence of (no) risk selection in health insurance markets? conceptual framework and empirical evidence
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313580/
https://www.ncbi.nlm.nih.gov/pubmed/26837411
http://dx.doi.org/10.1007/s10198-016-0764-7
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