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Solidarity in competitive health insurance markets: analysing the relevant EC legal framework

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  • Paolucci, Francesco
  • Exter, Andre Den
  • De Ven, Wynand Van

Abstract

In this article we perform an economic analysis of different regulatory frameworks that aim at guaranteeing solidarity in competitive health insurance markets. Thereafter, we analyse the legal conformity of these intervention strategies with EC law. We find that risk compensation schemes are the first-best intervention strategy because they guarantee an ‘acceptable level of solidarity’ without hindering free trade and competition and without reducing efficiency. Second-best options are premium and excess-loss compensation schemes, which guarantee solidarity at the expense of some efficiency. Premium rate restrictions and open enrolment should be avoided because they reduce efficiency and are unnecessary, not proportional, and undesirable to the pursuit of the general good. These conclusions are relevant for EU countries that adopt premium rate restrictions and open enrolment in combination with a risk compensation scheme, such as Ireland and the Netherlands. In these countries policy makers should design the health insurance schemes in conformity with EC law, for example by replacing premium rate restrictions and open enrolment with premium and/or excess-loss compensation schemes.

Suggested Citation

  • Paolucci, Francesco & Exter, Andre Den & De Ven, Wynand Van, 2006. "Solidarity in competitive health insurance markets: analysing the relevant EC legal framework," Health Economics, Policy and Law, Cambridge University Press, vol. 1(2), pages 107-126, April.
    • Handle: RePEc:cup:hecopl:v:1:y:2006:i:02:p:107-126_00
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    Cited by:

    1. Stefan Greß & Maral Manouguian & Jürgen Wasem, 2007. "Health Insurance Reform in the Netherlands," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 5(01), pages 63-67, May.
    2. Frederik T. Schut & Wynand P. M. M. Van de Ven, 2005. "Rationing and competition in the Dutch health‐care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 59-74, September.
    3. Francesco Paolucci & James R. G. Butler & Wynand P. M. M. van de Ven, 2011. "Removing Duplication in Public/Private Health Insurance in Australia: Opting Out With Risk-adjusted Subsidies?," Agenda - A Journal of Policy Analysis and Reform, Australian National University, College of Business and Economics, School of Economics, vol. 18(2), pages 49-70.
    4. Carlos Octávio Ocké-Reis, 2005. "A Reforma Institucional do Mercado de Planos de Saúde: Uma Proposta para Criação de Benchmarks," Discussion Papers 1075, Instituto de Pesquisa Econômica Aplicada - IPEA.
    5. Francesco Paolucci & Amir Shmueli, 2011. "The Introduction of Ex-ante Risk Equalisation in the Australian Private Health Insurance Market: A First Step," Agenda - A Journal of Policy Analysis and Reform, Australian National University, College of Business and Economics, School of Economics, vol. 18(2), pages 71-92.
    6. repec:ces:ifodic:v:5:y:2007:i:1:p:14567270 is not listed on IDEAS
    7. Francesco Paolucci & Femmeke Prinsze & Pieter Stam & Wynand Ven, 2009. "The potential premium range of risk-rating in competitive markets for supplementary health insurance," International Journal of Health Economics and Management, Springer, vol. 9(3), pages 243-258, September.
    8. Anne-Fleur Roos & Frederik Schut, 2012. "Spillover effects of supplementary on basic health insurance: evidence from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 51-62, February.
    9. Armstrong, John & Paolucci, Francesco & McLeod, Heather & van de Ven, Wynand P.M.M., 2010. "Risk equalisation in voluntary health insurance markets: A three country comparison," Health Policy, Elsevier, vol. 98(1), pages 39-49, November.
    10. Stefan Greß & Maral Manouguian & Jürgen Wasem, 2007. "Health Insurance Reform in the Netherlands," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 5(1), pages 63-67, 05.
    11. Connelly, Luke B. & Paolucci, Francesco & Butler, James R.G. & Collins, Paul, 2010. "Risk equalisation and voluntary health insurance markets: The case of Australia," Health Policy, Elsevier, vol. 98(1), pages 3-14, November.
    12. Armstrong, John, 2010. "Risk equalisation and voluntary health insurance markets: The case of Ireland," Health Policy, Elsevier, vol. 98(1), pages 15-26, November.

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