Choosing a health insurance plan

Each year, around 7% of consumers switch insurers, roughly 1.2 million policyholders. This means that most people stay with the same insurer as the year before. This is striking, especially given that the Authority for Consumers and Markets (ACM) and the Dutch Healthcare Authority (NZa) recently showed that many consumers could take out a policy with comparable coverage for a significantly lower premium. In 2023, 61% of consumers could save an average of 103 euros.

This raises an obvious question: why does such a large share of insured individuals stay with the same health insurance plan? And how do Dutch consumers actually make their health insurance choices?

Our ongoing research project at ESHPM aims to answer these questions. We are particularly interested in the barriers people experience when they consider switching but ultimately decide to stay where they are.

Why is the choice so difficult?

Choosing a health insurance plan is complex. Premiums, deductibles, coverage, contracted providers, and supplementary packages all play a role. These are all aspects consumers must consider, and they can vary substantially between insurers. For many people, the sheer number of options is overwhelming. Time constraints, limited capacity to process information, uncertainty about making the right choice, or the feeling that “it doesn’t really make much difference anyway” often lead to inertia: people stick with their current insurance.

What do we already know?

Previous research shows large differences in how difficult Dutch consumers find the choice of a health insurance plan. Earlier surveys also reveal the main reasons consumers give for switching or not switching insurers. The most important reasons for switching are “a premium that is too high” and a “change in healthcare needs.” The most important reasons for not switching are “being satisfied with the coverage” and “being satisfied with the insurer’s service.”

Within this latter group, however, other reasons also frequently appear, such as “finding the choice difficult,” “fear of not being accepted by another insurer,” “being afraid of the hassle involved in switching,” and “thinking it won’t make a difference anyway.” These reasons suggest that a portion of Dutch consumers experiences barriers that prevent them from making a well-informed choice.

What do we still want to understand?

In this project, we want to take a deeper look at the reasons consumers do or do not switch health insurers. We aim to understand in detail how people search for information, what they pay attention to, and which obstacles they encounter. So far, most studies have relied on surveys and other quantitative research methods. Our approach focuses instead on the decision-making process itself, using two qualitative research methods:

• Semi-structured interviews: We ask consumers about their experiences with choosing a health insurance plan and identify potential barriers in this way.
• Think-aloud study: We ask consumers to go through (part of) the steps they would normally take when searching for and comparing health insurance plans. At the same time, they verbalize their thoughts out loud. This allows us to observe both the decision-making process and what is going through consumers’ minds.

With this approach, we gain a nuanced picture of how health insurance decisions are made. The study is still ongoing, but based on our initial impressions we can already cautiously highlight a few interesting findings:

• The vast majority of participants use one or more comparison websites when choosing a health insurance plan, but the way they use them varies greatly. Some consumers use a comparison site as a first step and then continue their search on insurers’ websites, while others base their entire decision on the information from comparison sites and take out a policy immediately.
• Many people consider it important to know whether healthcare providers in their area have contracts with the insurer. The fact that this information is not always available at the time of comparison is a recurring source of frustration.
• Insurance-related terminology is not always well understood and can cause confusion, for example the difference between the percentage of providers that are contracted and the percentage that is reimbursed for non-contracted care.
• Some people appreciate having many different options to compare, such as a wide range of supplementary packages or different basic plans. Others, however, disengage because of the abundance of options and find these differences confusing.

This research provides insights that are relevant for insurers, policymakers, and anyone aiming to make it easier for consumers to make informed choices. You can follow our research at The Health Insurance Choice of the Dutch Consumer | Erasmus School of Health Policy & Management | Erasmus University Rotterdam.