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Selection Incentives for Health Insurers in the Presence of Sophisticated Risk Adjustment.

van Kleef, Richard C; Eijkenaar, Frank; van Vliet, René C J A.
Med Care Res Rev; : 1077558719825982, 2019 Feb 01.
Artigo em Inglês | MEDLINE | Fev 2019 | ID: mdl-30704337
Resumo: This article analyzes selection incentives for insurers in the Dutch basic health insurance market, which operates with community-rated premiums and sophisticated risk adjustment. Selection incentives result from the interplay of three market characteristics: possible actions by insurers, consumer response to these actions, and predictable variation in profitability of insurance contracts. After a qualitative analysis of the first two characteristics our primary objective is to identify the third. Using a combination of claims data ( N = 16.8 million) and survey information ( N = 387,195), we find substantial predictable variation in profitability. On average, people in good health are profitable, while those in poor health are unprofitable. We conclude that Dutch insurers indeed face selection incentives. A complete measure of selection incentives, however, captures the correlation between individual-level profitability and consumer response to insurer-actions. Obtaining insight in this correlation is an important direction for further research.