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Local availability of physicians' services as a tool for implicit risk selection

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  • Shmueli, Amir
  • Nissan-Engelcin, Esti

Abstract

Risk adjustment of the allocated health budget to health plans plays a major role in the functioning of competitive social health insurance systems. Whenever the risk adjusted allocation is below the expected marginal cost of care for a given person, incentives for risk selection arise. Since coverage is universal, risk selection must take on implicit forms such as stinting and distorting quality of health services. One of the tools for such selection is to strategically determine the local availability of physicians based on the local population. The Israeli competitive national health insurance scheme includes an age (only)-risk adjustment. We argue that the localities' known characteristics are used by the Israeli managed care organizations (sickness funds) to adjust the availability of and accessibility to community health services. Consequently, we expect strong competition and high availability of services in healthier-than-average (and richer) towns, and weak competition and low availability of services in sicker-than-average (and poorer) towns. The empirical analysis combines data on the reception hours of physicians in five specialties and socio-economic and demographic characteristics (age, mean income, mortality rates etc.) of 60 towns in 2004, and strongly confirms that hypothesis, controlling for several other possible explanations for such findings. Such a situation clearly represents a regulation failure and an inefficient and inequitable geographic allocation of health services.

Suggested Citation

  • Shmueli, Amir & Nissan-Engelcin, Esti, 2013. "Local availability of physicians' services as a tool for implicit risk selection," Social Science & Medicine, Elsevier, vol. 84(C), pages 53-60.
    • Handle: RePEc:eee:socmed:v:84:y:2013:i:c:p:53-60
    DOI: 10.1016/j.socscimed.2013.02.004
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    References listed on IDEAS

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    1. Amir Shmueli, 2015. "On the calculation of the Israeli risk adjustment rates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 271-277, April.
    2. Withagen-Koster, Anja A. & van Kleef, Richard C. & Eijkenaar, Frank, 2023. "Predictable profits and losses in a health insurance market with risk equalization: A multiple-contract period perspective," Health Policy, Elsevier, vol. 131(C).
    3. van de Ven, Wynand P.M.M. & Beck, Konstantin & Buchner, Florian & Schokkaert, Erik & Schut, Frederik T. & Shmueli, Amir & Wasem, Juergen, 2024. "Preconditions for efficiency and affordability in competitive healthcare markets: Are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland? Ten years later," Health Policy, Elsevier, vol. 146(C).
    4. Simón Ramírez Amaya & Adolfo J. Quiroz & Álvaro José Riascos Villegas, 2019. "Regression by clustering using metropolis-hastings," Documentos de Trabajo 18180, Quantil.
    5. Shuli Brammli-Greenberg & Jacob Glazer & Ruth Waitzberg, 2019. "Modest risk-sharing significantly reduces health plans’ incentives for service distortion," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(9), pages 1359-1374, December.
    6. Wynand P. M. M. Ven & René C. J. A. Vliet & Richard C. Kleef, 2017. "How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(2), pages 167-180, March.

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