Risk adjustment and risk selection on the sickness fund insurance market in five European countries

Ven, Wynand P.M.M. van de; Beck, Konstantin; Buchner, Florian; Chernichovsky, Dov; Gardiol, Lucien; Holly, Alberto; Lamers, Leida M.; Schokkaert, Erik; Shmueli, Amir; Spycher, Stephan; Voorde, Carine Van de; Vliet, René C.J.A. van; Wasem, Jürgen; Zmora, Irith

doi:10.1016/s0168-8510(02)00118-5

Cited by 117 publications

(72 citation statements)

References 14 publications

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“…Risk sharing lessens the degree of financial risk insurers bear and therefore lowers incentives for risk selection, but it also dampens incentives to operate efficiently (36). All four countries have strengthened their risk equalisation schemes in the last ten years and Belgium, Germany and the Netherlands now have relatively sophisticated formulas that include health-based risk adjusters (37)(38)(39).…”

Section: Risk Equalisationmentioning

confidence: 99%

Statutory health insurance competition in Europe: A four-country comparison

Thomson¹,

Busse

Crivelli

et al. 2013

Health Policy

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This article considers the potential for insurer competition to improve health system performance by strengthening purchasing. Economic theory suggests that insurer competition will enhance efficiency if: (1) people have free choice of insurer, (2) competition is based on price and quality rather than risk selection and (3) insurers have tools to influence health care costs and quality. The article assesses the extent to which these assumptions hold in Belgium, Germany, the Netherlands and Switzerland. It finds that health insurance market reforms in these countries have had mixed results in fulfilling these assumptions. In spite of significant investment in risk equalisation, incentives for risk selection remain. Consumer mobility is lower among older and chronically ill people, possibly due to close interaction between statutory and voluntary coverage. Although insurers in some countries increasingly have tools to enhance value, they may not always use them. The analysis suggests that the instrumental value of insurer competition rests on multiple assumptions that can only be upheld through frequently complex interventions often requiring elusive data. Making it work therefore requires action on several fronts, particularly to ensure incentives are aligned across the health system, and awareness of the political nature of some barriers to success.

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Section: Risk Equalisationmentioning

confidence: 99%

Statutory health insurance competition in Europe: A four-country comparison

Thomson¹,

Busse

Crivelli

et al. 2013

Health Policy

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“…And in spite of many attempts to improve this system, health economists still consider this complex RAS to be selective and imperfect because of a lack of knowledge of some of the reasons why people use health care (Van der Horst et al 2011). And, as health economists have consistently pointed out, developments outside the Netherlands have shown that imperfect funds, such as in Switzerland, contribute to the unequal treatment of persons within the health market (see for example Van de Ven et al 2003;Van Kleef et al 2007). They therefore continue to stress the importance of improving and fine-graining the RAS with increasingly detailed indicators for differences in health costs for different clients.…”

Section: Building a Device For Managing Solidarity: The Risk Adjustmementioning

confidence: 99%

Ineffable Cultures or Material Devices: What Valuation Studies can Learn from the Disappearance of Ensured Solidarity in a Health Care Market

Zuiderent‐Jerak

Egmond²

2015

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Valuation studies addresses how values are made in valuation practices. A next -or rather previous-question becomes: what then makes valuation practices? Two oppositional replies are starting to dominate how that question can be answered: a more materially oriented focus on devices of valuation and a more sociologically inclined focus on ineffable valuation cultures. The debate between proponents of both approaches may easily turn into the kind of leapfrog debates that have dominated many previous discussions on whether culture or materiality would play a decisive role in driving history. This paper explores a less repetitive reply. It does so by analyzing the puzzling case of the demise of solidarity as a core value within the recent Dutch health care system of regulated competition. While "solidarity among the insured" was both a strong cultural value within the Dutch welfare-based health system, and a value that was built into market devices by health economists, within a fairly short time "fairness" became of lesser importance than "competition". This makes us call for a more historical, relational, and dynamic understanding of the role of economists, market devices, and of culture in valuation studies.

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“…5 See glossary and for fuller explanations Schut (1995) and van Barneveld et al (2001). 6 In this regard we, where possible, replicate the definitions set out by Armstrong et al (2010) and van de Ven et al (2003).…”

Section: Outline Of Articlementioning

confidence: 99%

“…Glossary (amended from Van de Ven et al (2003) and Armstrong et al (2010) Direct standardisation: direct standardisation method transforms expenditures by applying a standard needs profile to the actual expenditure profile of the group.…”

Section: Appendixmentioning

confidence: 99%