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Applied Health Economics and Health Policy
Published in: Applied Health Economics and Health Policy 4/2004

01-12-2004 | Article

Consumer mobility in social health insurance markets

A five-country comparison

Authors: Dr Trea Laske-Aldershof, Erik Schut, Konstantin Beck, Stefan Greß, Amir Shmueli, Carine Van de Voorde

Published in: Applied Health Economics and Health Policy | Issue 4/2004

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Abstract

During the 1990s, the social health insurance schemes of Germany, the Netherlands, Switzerland, Belgium and Israel were significantly reformed by the introduction of freedom of choice (open enrolment) of health insurer. This was introduced alongside a system of risk adjustment to compensate health insurers for enrolees with predictable high medical expenses. Despite the similarity in the health insurance reforms in these countries, we find that both the rationale behind these reforms and their impact on consumer choice vary widely.
In this article we seek to explain the observed variation in switching rates by cross-country comparison of the potential determinants of health insurer choice. We conclude that differences in choice setting, and in the net benefits of switching, offer a plausible explanation for the large differences in consumer mobility.
Finally, we discuss the policy implications of our cross-country comparison. We argue that the optimal switching rate crucially depends on the goals of the reforms and the quality of the risk-adjustment system. In view of this, we conclude that switching rates are currently too low in the Netherlands, and an active government policy to encourage consumer mobility seems warranted. In Germany and Switzerland, high switching rates call for an improvement of the rather poor risk-adjustment systems. Given low switching rates in Israel and Belgium, improving risk adjustment is less urgent, but still required in the long run.
Footnotes
1
1Furthermore, because the estimated price elasticities are typically calculated at the mean, the magnitude of price elasticities depends on the average market share and premium level, which vary widely between the different countries.
 
2
2Notice that usually only net switching rates per health insurer are observable. Hence, the total number of switchers is likely to be higher than reflected in the reported switching rates.
 
3
3Belgium has a compulsory national health insurance system for a basic package that covers major health risks (e.g. hospitalisations) for the entire
 
4
4The total premium range is even larger than the existing premium differentiation for the same level coverage because sickness funds are allowed to offer premium discounts if their enrolees opt for a higher deductible.
 
5
5That switching propensity is negatively related to age and positively related to health and education is also found by empirical studies in the US,[16‐19] the Netherlands,[20,21] Belgium[5] and Israel.[22]
 
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Schut FT, Greß S, Wasem J. Consumer price sensitivity and social health insurer choice in Germany and the Netherlands. Int J Health Care Finance Econ 2003: 3: 117–38PubMedCrossRef
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Laske-Aldershof T, Schut FT. Effects of switching costs and consumer information on health insurer choice in the Netherlands [paper presentation]. Fourth World Congress of the International Health Economics Association; 2003 Jun 15-18; San Francisco
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Metadata
Title
Consumer mobility in social health insurance markets
A five-country comparison
Authors
Dr Trea Laske-Aldershof
Erik Schut
Konstantin Beck
Stefan Greß
Amir Shmueli
Carine Van de Voorde
Publication date
01-12-2004
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 4/2004
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.2165/00148365-200403040-00006

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