Abstract
Recently in many countries market oriented strategies have been implemented or proposed in order to improve efficiency in health care. In several countries (e.g. the Netherlands, Australia, Germany, Israel, Switzerland and the United States of America (USA)) an essential aspect of these strategies is that competing insurers receive a risk-adjusted premium-replacing payment per insured. In return the insurers are responsible for paying for or delivering the services as described in the benefits package. The payment per insured is dependent on the risk category to which the insured belongs and provides the insurer with an incentive for efficiency. However, if the risk groups are heterogeneous, cream skimming may arise, resulting in adverse effects to society in terms of reduced (incentives for) quality and efficiency of care.
This paper has been presented at the Second World Congress on Health Economics, September 1990, in Zürich. The authors wish to thank Brad Kirkman-Liff, Andrew Street and Peter Zweifel for their valuable comments on a previous draft.
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van de Ven, W.P.M.M., van Vliet, R.C.J.A. (1992). How can we prevent cream skimming in a competitive health insurance market?. In: Zweifel, P., Frech, H.E. (eds) Health Economics Worldwide. Developments in Health Economics and Public Policy, vol 1. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-2392-1_2
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