Risk Sharing

Can risk rating increase the ability of voluntary deductibles to reduce moral hazard?

“…Our results are not only relevant for Chile, but also for other countries with social health insurance systems that rely on premium regulation such as the Netherlands, Switzerland, the U.S., Germany (McGuire and van Kleef 2018 ), Australia, Chile and New Zealand (Armstrong and Paolucci 2010 ; Radermacher et al 2016 ; Henriquez et al 2019 ; Velasco et al 2018 ). It is well-known that some RR can help overcome risk selection by consumers and insurers (van Kleef et al 2006 , 2008 ; Kifmann 2002 ).…”

“…A primary motivation for this cost-sharing option is to mitigate moral hazard (MH) (Cutler and Zeckhauser 2000 ). Examples include the mandatory health insurance schemes in the Netherlands and Switzerland, and the marketplaces in the U.S. (McGuire and van Kleef 2018 ). In the Netherlands, premiums (and premium rebates) are community rated per health plan, meaning that all consumers with the same plan pay the same premium.…”

“…consolidated public–private mix with tints of social insurance principles—such as Ireland and Australia) and to those debating the structure of their health systems to manage expenditures while keeping up with consumers expectations (i.e. Australia, New Zealand, Switzerland, the Netherlands, the U.S.) (Robson and Paolucci 2012 ; McGuire and van Kleef 2018 ; Henriquez et al 2019 ). Indeed, the regulatory tools discussed in the paper are commonly implemented in insurance markets to balance efficiency and fairness (van Kleef et al 2018 ): voluntary deductibles can help counteract moral hazard; premium rate restrictions (i.e.…”

Stents versus bypass surgery: 3-year mortality risk of patients with coronary interventions aged 50+ in Germany

“…We reduced the problem of false-positive CAD diagnoses by applying a validation strategy: to define the first CAD diagnosis as valid, the patient required the co-occurrence of CAD diagnosis in another quarter over the whole observation period [ 9 ]. We considered all covariates, with the exception of sex and age at incident CAD diagnosis, to be time-varying variables with value 1 since first valid diagnosis and 0 otherwise.…”

How to deal with persistently low/high spenders in health plan payment systems?

“…Several health insurance systems rely on premium‐rate restrictions to promote fairness and/or mitigate reclassification risk. Examples include mandatory health insurance schemes in Belgium, Germany, Israel, the Netherlands, and Switzerland; voluntary health insurance markets in Ireland and Australia; and Medicare Advantage and the Marketplaces in the United States (McGuire & van Kleef, 2018 ). A well‐known problem of premium‐rate restrictions, however, is that they confront insurers with predictable profits and losses, which generate incentives for risk selection.…”