Abstract
In this paper, we examine the effects of the introduction of free choice and price competition in social health insurance in Germany and the Netherlands. Using panel data at the sickness fund level we estimate the price elasticity of sickness fund choice in both countries. We find that the price elasticity in Germany is high and rapidly increasing. Consistent with findings of other studies on health plan choice, the price elasticity is much lower for elderly than for non-elderly. In the Netherlands, by contrast, the price elasticity of fund choice is negligible. Only when people were forced to choose a sickness fund, they were quite sensitive to premium differences. Key factors in explaining the observed differences in switching behavior between both countries are the degree of financial risk for sickness funds, the features of the risk-adjustment mechanism and the role of employers.
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References
Andersen, H. H. and J. Schwarze. (1998). “GKV '97: Kommt Bewegung in die Landschaft? Eine empirische Analyse der Kassenwahlentscheidungen (Statutory health insurance in 1997: Is there any movement in the landscape? An empirical analysis of sickness fund choice decisions).” Arbeit und Sozialpolitik 9/10, 11–23.
Barringer, M.W. and O. S. Mitchell. (1994). “Workers' Preferences Among Company-Provided Health Insurance Plans.” Industrial and Labor Relations Review 48(1), 141–152.
Berry, S. T. (1994). “Estimating Discrete-Choice Models of Product Differentiation.” RAND Journal of economics 25(2), 242–262.
Bishop, Y. M. M., S. E. Fienberg and P.W. Holland. (1975). Discrete Multivariate Analysis: Theory and Practice, Cambridge, MA: MIT Press.
Buchmueller, T. C. (2000). “The Health Plan Choices of Retirees under Managed Competition.” Health Services Research 35(5), 949–976.
Buchmueller, T. C. and P. J. Feldstein. (1997). “The Effect of Price on Switching Among Health Plans.” Journal of Health Economics 16, 231–247.
Buchner, F. and J. Wasem. (2003). “Needs for Further Improvement: Risk Adjustment in the German Health Insurance System.” Health Policy, in press.
Chernew, M. and D. P. Scanlon. (1998). “Health Plan Report Cards and Insurance Choice.” Inquiry 35, 9–22.
Cutler, D. M. and S. J. Reber. (1998). “Paying for Health Insurance: The Trade-off Between Competition and Adverse Selection.” Quarterly Journal of Economics 113(2), 433–466.
Dowd, B. and R. Feldman. (1994). “Premium Elasticities of Health Plan Choice.” Inquiry 31, 438–444.
Enthoven, A. C. (1978). “Consumer Choice Health Plan.” New England Journal of Medicine 298, 650–658, 709-720.
Enthoven, A. C. (1988). Theory and Practice of Managed Competition in Health Care Finance. North-Holland, Amsterdam.
Feldman, R., M. Finch, B. Dowd and S. Cassou. (1989). “The Demand for Employment-Based Health Insurance Plans.” Journal of Human Resources 24(1), 115–142.
Greß, S., P. Groenewegen, J. Kerssens, B. Braun and J. Wasem. (2002). “Free Choice of Sickness Funds in Regulated Competition: Evidence from Germany and The Netherlands.” Health Policy 60(3), 235–254.
Hassink, W. H. J. (1998). “Is er concurrentie tussen ziekenfondsen? (Do Sickness Funds Compete?).” Economisch Statistische Berichten 83, 616–618.
Jacobs, K., P. Reschke, D. Cassel and J. Wasem. (2002). Zur Wirkung des Risikostrukturausgleichs in der Gesetzlichen Krankenversicherung–Eine Untersuchung im Auftrag des Bundesministeriums für Gesundheit: Endbericht, Nomos, Baden-Baden.
Kalshoven, C. (1999). “Ziekenfondsverzekerden: zit er beweging in? (Sickness Fund Enrollees: Is There Any Movement?).” Openbare Uitgaven 31, 40–47.
Kerssens, J. J., D. M. J. Delnoij, J. A. Verweij and E. van der Schee. (2002). “De keuze van ziekenfondsverzekerden voor een zorgverzekeraar (Health Insurer Choice by Sickness Fund Enrollees).” Tijdschrift voor Gezondheidswetenschappen 80(1), 35–42.
Lamers, L. M. (1999). “Pharmacy Cost Groups. A Risk-Adjuster for Capitation Payments Based on the Use of Prescribed Drugs.” Medical Care 37(8), 824–830.
Laske-Aldershof, T. and F. T. Schut. (2002). “Switching Behavior of Consumers in Dutch Social Health Insurance.” Paper Presented at the 4th European Conference on Health Economics, Paris, July 8-10, 2002.
Levy, H. and R. Feldman. (2001). “Does the Incidence of Group Health Insurance Fall on Individual Workers?” International Journal of Health Care Finance and Economics 1, 227–247.
McFadden, D. (1974). “Conditional Logit Analysis of Qualitative Choice Behavior.” In P. Zarembka (ed.), Frontiers in Econometrics. (pp. 105–142). New York: Academic Press.
Rebscher, H. (1995). “Der Arbeitgeberbeitrag in der GKV: Seine Rolle im Konzept einer Solidarischen Wettbewerbsordnung (The Employer Contribution to Social Health Insurance: Its RoleWithin the Concept of Socially Bounded Competition).” Gesellschaftspolitische Kommentare 36(12), 533–538.
Royalty, A. B. and N. Solomon. (1999). “Health Plan Choice. Price Elasticities in a Managed Competition Setting.” Journal of Human Resources 34(1), 1–41.
Samuelson, W. and R. Zeckhauser. (1988). “Status Quo Bias in Decision-Making.” Journal of Risk and Uncertainty 1, 7–59.
Scanlon, D. P., M. Chernew, C. McLaughlin and G. Solon. (2002). “The Impact of Health Plan Report Cards on Managed Care Enrollment.” Journal of Health Economics 21, 19–41.
Schut, F. T. (2001). “Prijsconcurrentie ziekenfondsen nog niet effectief (Price Competition Between Sickness Funds Not Yet Effective).” Economisch Statistische Berichten 86, 172–175.
Schut, F. T. and W. H. J. Hassink. (2002). “Managed Competition and Consumer Price Sensitivity in Social Health Insurance.” Journal of Health Economics 21, 1009–1029.
Schwarze, J. and H. H. Andersen. (2001). “Kassenwechsel in der Gesetzlichen Krankenversicherung: Welche Rolle spielt der Beitragssatz? (Switching Funds in Statutory Health Insurance: What Role is Played by the Contribution Rate?).” Discussion paper 267, Deutsches Institut für Wirtschaftsforschung, Berlin.
Strombom, B. A., T. C. Buchmueller and P. J. Feldstein. (2002). “Switching Costs, Price Sensitivity and Health Plan Choice.” Journal of Health Economics 21, 89–116.
Van Barneveld, E. M., R. C. J. A. van Vliet and W. P. M. M. van de Ven. (2001). “Risk Sharing Between Competing Health Plans and Sponsors.” Health Affairs 20(3), 253–262.
Van de Ven, W. P. M. M., R. C. J. A. van Vliet, F. T. Schut and E. M. van Barneveld. (2000). “Access to Coverage for High-Risks in a Competitive Individual Insurance Market: Via Premium Rate Restrictions or Risk-Adjusted Premium Subsidies.” Journal of Health Economics 19, 311–339.
Varkevisser, M. and S. A. van der Geest. (2001). “Price Competition Among Dutch Sickness Funds.” Research Memorandum 0112, OCFEB Research Centre for Economic Policy, Erasmus University Rotterdam (http://www.ocfeb.nl).
Welch, W. P. (1986). “The Elasticity of Demand for Health Maintenance Organizations.” Journal of Human Resources 21(2), 252–266.
WSI-Tarifarchiv. (2001). Tarifbindung 1998-2000 (Share of employees covered by collective labor agreements 1998-2000), http://www.boeckler.de/wsi/tarchiv/tiu/bindung/tbindung98 2000xl.htm, Accessed on August 1, 2002.
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Schut, F.T., Greß, S. & Wasem, J. Consumer Price Sensitivity and Social Health Insurer Choice in Germany and the Netherlands. International Journal of Health Care Finance and Economics 3, 117–138 (2003). https://doi.org/10.1023/A:1023369231291
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DOI: https://doi.org/10.1023/A:1023369231291