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The goal of risk equalization in regulated competitive health insurance markets

Author

Listed:
  • Wynand Ven

    (Erasmus University Rotterdam)

  • Gerrit Hamstra

    (Equalis Strategy and Modeling)

  • Richard Kleef

    (Erasmus University Rotterdam)

  • Mieke Reuser

    (Erasmus University Rotterdam)

  • Piet Stam

    (Equalis Strategy and Modeling
    VU University Amsterdam)

Abstract

Different opinions exist about the goal of risk equalization in regulated competitive health insurance markets. There seems to be consensus that an element of the goal of risk equalization is ‘to remove the predictable over- and undercompensations of subgroups of insured’ or, equivalently, ‘to achieve a level playing field for each risk composition of an insurer’s portfolio’ or, equivalently, ‘to remove the incentives for risk selection’. However, the role of efficiency appears to be a major issue: should efficiency also be an element of the goal of risk equalization, or should it be a restriction to the goal, or should efficiency not be an element of the goal or a restriction to the goal? If efficiency plays a role, a comprehensive analysis of the total effect of risk equalization on efficiency needs to be done. An improvement of the performance of a risk equalization scheme has both negative and positive effects on efficiency. Negative effects include the reduction in efficiency via cost- or utilization-based risk adjusters. Positive effects result from leveling the playing field and reducing the incentives for risk selection, which increase efficiency as the outcome of a competitive market. In practice many regulators and policy makers take efficiency into consideration by looking at the negative effects, but hardly at the positive effects. The definition of the goal of risk equalization has consequences for the design and evaluation of risk equalization schemes and for the equalization payments. We describe relevant potential goals, tradeoffs and possible solutions.

Suggested Citation

  • Wynand Ven & Gerrit Hamstra & Richard Kleef & Mieke Reuser & Piet Stam, 2023. "The goal of risk equalization in regulated competitive health insurance markets," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(1), pages 111-123, February.
    • Handle: RePEc:spr:eujhec:v:24:y:2023:i:1:d:10.1007_s10198-022-01457-7
    DOI: 10.1007/s10198-022-01457-7
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    References listed on IDEAS

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    Cited by:

    1. Ismail, I. & Stam, P.J.A. & Portrait, F.R.M. & van Witteloostuijn, A. & Koolman, X., 2024. "Addressing unanticipated interactions in risk equalization: A machine learning approach to modeling medical expenditure risk," Economic Modelling, Elsevier, vol. 130(C).
    2. Tuukka Holster & Shaoxiong Ji & Pekka Marttinen, 2024. "Risk adjustment for regional healthcare funding allocations with ensemble methods: an empirical study and interpretation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(7), pages 1117-1131, September.

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    More about this item

    Keywords

    Risk equalization; Efficiency; Level playing field; Risk selection;
    All these keywords.

    JEL classification:

    • G18 - Financial Economics - - General Financial Markets - - - Government Policy and Regulation
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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