Themes

The group Health Insurance is concerned with the following research areas:

Consumer behaviour on the care insurance market

Description

Health insurance funds and private care insurers are gradually being given increasing responsibility for purchasing care for their clients. Each year, consumers are given the opportunity to choose between the various care insurers on the market, based on premium levels and quality. But are consumers aware of this? This project provides more insight into the degree to which the consumer is informed about care insurance, his reasons for switching to or staying with a particular care insurer, and his sensitivity to cost and to the quality of care purchased by care insurers. It also focuses on the possible risk selection of health insurers and the potentially negative effects this may have on consumers.

Researchers

Trea Laske-Aldershof (contact)Tel: (31)104088560laske@eshpm.eur.nl
Doeska de BruijnTel: (31)104088533d.debruijn@erasmusmc.nl
Wynand van de VenTel: (31)104088556vandeven@eshpm.eur.nl
Erik SchutTel: (31)104088558schut@eshpm.eur.nl

Recent publications

Dijk, M., M. Pomp, R. Douven, T. Laske-Aldershof, F.T. Schut, W. de Boer and A. de Boo (2006). "Consumer price sensitivity in health insurance." Discussion paper. 

 

Cost sharing

Description

The major goal of cost sharing in health insurance is to reduce moral hazard. The extent of such a reduction is influenced by the insured's characteristics, the form of cost sharing and its interaction with other parts of an insurance system (such as risk equalization). Next to the effect on medical consumption, cost sharing might also affect the level of cross-subsidization between the healthy and the unhealthy. 

Our research on cost sharing focuses on all of these aspects.

Researchers

Richard van Kleef (contact)Tel: (31)104082821vankleef@eshpm.eur.nl
René van VlietTel: (31)104088585vanvliet@eshpm.eur.nl
Wynand van de VenTel: (31)104088556vandeven@eshpm.eur.nl

Recent publications

Kleef, R.C. van, K. Beck, W.P.M.M. van de Ven en R.C.J.A. van Vliet. (2007). "Risk equalization and voluntary deductibles: a complex interaction", Journal of Health Economics, forthcoming.
Kleef, R.C. van, K. Beck, W.P.M.M. van de Ven en R.C.J.A. van Vliet. (2007). "Does risk equalization reduce the viability of voluntary deductibles?" International Journal of Health Care Finance and Economics 7: 43-58.
Kleef, R.C. van, W.P.M.M. van de Ven en R.C.J.A. van Vliet. (2006). "Premium Rebate in Exchange for a Voluntary Deductible in Social Health Insurance with Risk Equalization: Community-rated or Risk-rated?"Journal of Risk and Insurance 73: 529-550.
Bakker, F.M., R.C.J.A. van Vliet, and W.P.M.M. van de Ven. (2000). "Deductibles in health insurance: can the actuarially fair premium reduction exceed the deductible?" Health Policy 53(2): 123-41.

 

Regulated competition in health care markets

Description

In the new Dutch health care system competing health insurers increasingly have to act as prudent buyers of health care. Since 1 February 2005, for example, insurers must negotiate with individual health providers about price, quantity and quality of approximately 10% of total hospital expenditure. Also in the market for pharmaceuticals health insurers are expected to play a more important role in the (near) future. A careful deregulation of health care markets, however, requires a detailed analysis of the relevant economic characteristics for a particular health service (e.g. emergency care, mental health care, pharmaceuticals). Within the research theme "Regulated competition in health care markets" we especially analyse for which health services the introduction of insurer-health provider bargaining is feasible. On this subject we regularly cooperate with the Erasmus Competition and Regulation institute (www.ecri.nl).

Researchers

Erik Schut (contact)Tel: (31)104088558schut@eshpm.eur.nl
Marco VarkevisserTel: (31)104088850/1489varkevisser@eshpm.eur.nl

Recent consultancy reports (partly in Dutch):

Douven, R. and F.T. Schut (2006). "Health plan pricing behaviour and managed competition."Discussion paper.Text
Gereguleerde concurrentie in de planbare curatieve GGZ? Een economische analyse ('Regulated competition in mental health care markets? An economic analysis'), report prepared for GGZ Nederland, 2005 
Concurrentie tussen Nederlandse ziekenhuizen: de deelmarkt voor reguliere klinische zorg ('Competition among Dutch hospitals: the market for regular clinical hospital care'), Studies in Economic Policy, nr. 13, OCFEB/ESHPM, Erasmus Universiteit Rotterdam, report prepared for the Ministry of Health, Welfare and Sports (VWS), 2004 
Gereguleerde concurrentie in de curatieve zorg: de deelmarkten spoedeisende zorg en electieve zorg in dagbehandeling ('Regulated competition in markets for curative care: emergency care and outpatient care'), Studies in Economic Policy, nr. 11, OCFEB/ESHPM, Erasmus Universiteit Rotterdam, report prepared for the Ministry of Health, Welfare and Sports (VWS), 2003 
Zorgvuldig dereguleren: een analysekader voor de curatieve zorg ('Careful deregulation: a conceptual framework for curative care markets'), Studies in Economic Policy, nr. 8, OCFEB/ESHPM, Erasmus Universiteit Rotterdam, report prepared for the Ministry of Health, Welfare and Sports (VWS), 2003 

Recent articles and chapters in books (partly in Dutch):

"Rationing and competition in the Dutch health-care system." Health Economics 14 (S1): S59-S74.
"Market-oriented health care reforms and policy learning in the Netherlands." Journal of Health Politics, Policy and Law 30 (1-2): 189-209.
Gezondheidszorg ('Health care'), in C.A. de Kam en A.P. Ros (red.), Jaarboek overheidsfinanciën 2005 ('Yearbook of public finance 2005'), Sdu Uitgevers, Den Haag, 97-121, 2005.
"De preferente apotheker? Jazeker! ('Preferred pharmacists')." Economisch Statistische Berichten 2004: 266-269.
Gezondheidszorg ('Health care'), in C.A. de Kam en A.P. Ros (red.), Jaarboek overheidsfinanciën 2004 'Yearbook of public finance 2004'), Sdu Uitgevers, Den Haag, 129-148, 2004.
"Eerlijk prijzen in de zorg ('Good pricing in health care')." Economisch Statistische Berichten 2003: 470-472.
"Deregulering zorgaanbod vereist maatwerk ('Deregulation of health care requires tailor-made policy measures')." Tijdschrift voor Openbare Financiën 35 (3): 98-108.

 

Risk Equalization

Description

In January 2006 the Dutch government introduces a compulsory basic health insurance scheme for all Dutch citizens. An essential aspect of the regulation is a risk equalization system, which has been developed for the social sickness fund market from 1991 onwards. With a risk equalization system the insurers receive risk adjusted payments, which reflect the health risk profile of their clients as closely as possible to avoid risk selection. The research in this area focuses on the following questions:

  1. How can the system of risk adjusted payments be improved?
  2. Which measures can be taken to discourage risk selection?

Researchers

René van Vliet (contact)Tel: (31)104088585vanvliet@eshpm.eur.nl
Femmeke PrinszeTel: (31)104088551f.prinsze@erasmusmc.nl
Wynand van de VenTel: (31)104088556vandeven@eshpm.eur.nl

Recent publications

Van de Ven, W.P.M.M. and F.T. Schut. (2007). "Risk equalization in an individual health insurance market: the only escape from the tradeoff between affordability, efficiency and selection - the Netherlands as a case study" This working paper is part of the project "FRESH-thinking" directed by Ezekiel J. Emanuel and Victor R. Fuchs . 
Van Vliet , R.C.J.A. (2006). "Free choice of health plan combined with risk-adjusted capitation payments: are switchers and new enrolees good risks?" Health Economics, in press. 
Van de Ven, W.P.M.M., R.C.J.A. van Vliet, and L.M. Lamers. (2004). "Health-adjusted premium subsidies in the Netherlands." Health Affairs (Millwood) 23 (3): 45-55. 
Lamers, L.M., R.C.J.A. van Vliet, and W.P.M.M. van de Ven. (2003). "Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands." Health Policy 65 (1): 49-62. 
Lamers, L.M., and R.C.J.A. van Vliet. (2003). "The Pharmacy-based Cost Group Model: Validating and adjusting the classification of medications for chronic conditions to the Dutch situation."Health Policy 68: 113-121. 
Lamers, L.M., and R.C.J.A. van Vliet. (2003). "Health-based risk adjustment: improving the Pharmacy-based Cost Group model to reduce gaming possibilities." European Journal of Health Economics 4: 107-114. 
Van de Ven, W.P.M.M., K. Beck, F. Buchner, D. Chernichovsky, L. Gardiol, A. Holly et al. (2003). "Risk adjustment and risk selection on the sickness fund insurance market in five European countries." Health Policy 65 (1): 75-98. 

 

Basic and supplementary health care financing schemes in different countries: a complex interaction

Description

The escalation in health costs together with the increasingly constrained public resources of financing has been pressing policy-makers in many countries to search for suitable alternatives to finance health care. Several OECD countries' governments consider supplementary health insurance as one of the primary instruments for limiting statutory financing of health care. In this project, a conceptual framework is proposed in order to investigate the interactions between basic and supplementary health care financing schemes in different countries (e.g. Australia, Belgium, France, Germany, Ireland, Israel, the Netherlands, Switzerland, and the United States). The institutional settings, the market structure and the regulations of health care financing schemes for both basic and supplementary services are analyzed for each country. The three main area of focus are the following:

  1. Theoretical analysis of the economic rationales for the enforcement of mandatory cross-subsidies and mandatory coverage. This analysis provides the basis for a classification of health care financing schemes along the categories basic/supplementary services and mandatory/voluntary coverage.
     
  2. Econometric analysis, which aims at providing empirical evidence of the potential loss of risk-solidarity produced by the transfer of benefits from mandatory basic health insurance with community-rated premiums to voluntary supplementary health insurance with (potentially) risk-rated premiums.
     
  3. Economic analysis of several intervention strategies adopted by governments to regulate competition in health insurance markets with the aim of achieving solidarity. The purpose of this analysis is to determine the first best intervention strategy to introduce for achieving solidarity in competitive health insurance markets, from an economic perspective. Then we evaluate the potential impact of supranational law (i.e. EC-law and GATS) on national regulations sustaining solidarity in competitive basic and supplementary health insurance markets.
     
  4. International comparison, with focus on whether supplementary health insurance is likely to be used as a tool for risk-selection in five countries' competitive mandatory basic health insurance markets (ie. Belgium, Germany, Isreal, the Netherlands, Switzerland).

Researchers

Francesco Paolucci (contact)Tel: (31)104088535f.paolucci@eshpm.eur.nl
Wynand van de VenTel: (31)104088556vandeven@eshpm.eur.nl

Recent publications

Paolucci F., A. den Exter, and W.P.M.M. van de Ven. (2005). "Solidarity in competitive health insurance markets: analysing the relevant EC legal framework." Health Economics, Policy and Law, To be published. 

 

Health Economics

Description

The project is designed to widen insight into the essential role played by health insurance in upholding a fair and appropriate health care system and hence in helping to create an optimum medical insurance system. Key topics that the project focusses on are: collective contracts, selection, a balanced market, an appropriate care policy, choices in care, purchasing care, system amendments (basic insurance) and international comparisons.

Contact

Wynand van de VenTel: (31)104088556vandeven@eshpm.eur.nl