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Krankenkassenwettbewerb in der GKV: Evidenz für Risikoselektion?

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  • Robert Nuscheler

Abstract

In 1996, free choice of sickness fund was given to those insured under the German Public Health Insurance System, thus significantly intensifying competition among funds. As funds must not charge risk-related premiums (community rating), there are substantial selection incentives, i.e. funds have incentives to engage in active risk selection to improve their risk pool. In this paper we argue that the distortions observed in the German Public Health Insurance market do not originate from active but from passive risk selection. Thus, the problem is not competition but its insufficient organization. Improved risk adjustment would mitigate this problem and would, additionally, allow for more competition on the market. Seit 1996 können die Versicherten in der gesetzlichen Krankenversicherung Deutschlands (GKV) ihre Krankenkasse frei wählen. Der Wettbewerb zwischen den Kassenwurde damit erheblich verstärkt. Wegen des Verbots risikoabhängiger Prämien (Diskriminierungsverbot) haben die Krankenkassen einen Anreiz, aktiv Risikoselektion zu betreiben - sich also aktiv um eine Verbesserung ihres Risikopools zu bemühen. In diesem Beitrag wird argumentiert, dass die Wettbewerbsverzerrungen in der GKV nicht auf aktive, sondern auf passive Risikoselektion zurückzuführen sind. Das Problem liegt also nicht im Wettbewerb selbst, sondern in der schlechten Organisation des Wettbewerbs. Ein verbesserter Risikostrukturausgleich würde dieses Problem entschärfen und zudem eine weitere Stärkung des Wettbewerbs ermöglichen.

Suggested Citation

  • Robert Nuscheler, 2004. "Krankenkassenwettbewerb in der GKV: Evidenz für Risikoselektion?," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 73(4), pages 528-538.
    • Handle: RePEc:diw:diwvjh:73-40-4
    DOI: 10.3790/vjh.73.4.528
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    References listed on IDEAS

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