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A framework for ex-ante evaluation of the potential effects of risk equalization and risk sharing in health insurance markets with regulated competition

Author

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  • Richard C. Kleef

    (Erasmus University Rotterdam, Erasmus Centre for Health Economics Rotterdam (EsCHER))

  • Mieke Reuser

    (National Institute for Public Health and the Environment (RIVM))

  • Pieter J.A. Stam

    (Vrije Universiteit Amsterdam)

  • Wynand P.M.M. Ven

    (Erasmus University Rotterdam, Erasmus Centre for Health Economics Rotterdam (EsCHER))

Abstract

Many health insurance markets are organized by principles of regulated competition. Regulators of these markets typically apply risk equalization (aka risk adjustment) and risk sharing to mitigate risk selection. Risk equalization and risk sharing can have various positive and negative effects on efficiency and fairness. This paper provides a comprehensive framework for ex-ante evaluation of these effects. In a first step, we distinguish 22 potential effects. In a second step, we summarize and discuss quantitative measures used for evaluating risk equalization and risk sharing schemes in academic research. To underline the relevance of our work, we compare our framework with an existing framework that was previously used in the Dutch regulated health insurance market. We conclude that this framework is incomplete and uses inappropriate measures. To avoid suboptimal policy choices, we recommend policymakers (1) to consider the entire spectrum of potential effects and (2) to select their measures carefully.

Suggested Citation

  • Richard C. Kleef & Mieke Reuser & Pieter J.A. Stam & Wynand P.M.M. Ven, 2024. "A framework for ex-ante evaluation of the potential effects of risk equalization and risk sharing in health insurance markets with regulated competition," Health Economics Review, Springer, vol. 14(1), pages 1-15, December.
    • Handle: RePEc:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-024-00540-4
    DOI: 10.1186/s13561-024-00540-4
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    References listed on IDEAS

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    1. Beaulieu Nancy & Cutler David M & Ho Katherine & Isham George & Lindquist Tammie & Nelson Andrew & O'Connor Patrick, 2006. "The Business Case for Diabetes Disease Management for Managed Care Organizations," Forum for Health Economics & Policy, De Gruyter, vol. 9(1), pages 1-38, December.
    2. Richard C. van Kleef & René C. J. A. van Vliet, 2022. "How to deal with persistently low/high spenders in health plan payment systems?," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 784-805, May.
    3. David M. Cutler & Sarah J. Reber, 1998. "Paying for Health Insurance: The Trade-Off between Competition and Adverse Selection," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 113(2), pages 433-466.
    4. Erik van Barneveld & Leida Lamers & René van Vliet & Wynand van de Ven, 2000. "Ignoring small predictable profits and losses: a new approach for measuring incentives for cream skimming," Health Care Management Science, Springer, vol. 3(2), pages 131-140, February.
    5. Nyman, John A., 1999. "The economics of moral hazard revisited," Journal of Health Economics, Elsevier, vol. 18(6), pages 811-824, December.
    6. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
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