The Experts below are selected from a list of 339 Experts worldwide ranked by ideXlab platform
Wynand P.m.m. Van De Ven - One of the best experts on this subject based on the ideXlab platform.
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consumer choice among mutual Healthcare purchasers a feasible option for china
Social Science & Medicine, 2013Co-Authors: Wynand P.m.m. Van De VenAbstract:Abstract In its 2009 blue print of Healthcare reform, the Chinese government aimed to create a competitive Health Insurance Market in order to increase efficiency in the Health Insurance sector. A major advantage of a competitive Health Insurance Market is that insurers are stimulated to act as well-motivated prudent purchasers of Healthcare on behalf of their enrolees, and that consumers can choose among these purchasers. To emphasize the insurers' role of purchasers of care we denote them, as well as other entities that can fulfil this role (e.g. fundholding community Health centres), as ‘Mutual Healthcare Purchasers’ (MHPs). As feasible proposals for creating competition in China's Health Insurance sector have yet to be made, we suggest two potential approaches to create competition among MHPs: (1) separating finance and operation of social Health Insurance and allowing consumer choice among operators of social Health Insurance schemes; (2) allowing consumer choice among fund-holding community Health centres. Although the benefits of competition are widely accepted in China, the problematic consequences of a free competitive Health Insurance Market – especially in relation to affordability and accessibility – are generally neglected. To solve the problems of lack of affordability and inaccessibility that would occur in the case of unregulated competition among MHPs, at least the following regulations are proposed to the Chinese policy makers: a ‘standard benefit package’ for basic Health Insurance, a ‘risk-equalization scheme’, and ‘open enrolment’. Potential obstacles for implementing a risk equalization scheme are examined based on theoretical arguments and international experiences. We conclude that allowing consumer choice among MHPs and implementing a risk equalization scheme in China is politically and technically complex. Therefore, the Chinese government should prepare carefully for a Market-oriented reform in its Healthcare sector and adopt a strategic approach in the implementation procedure.
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risk selection in a regulated Health Insurance Market a review of the concept possibilities and effects
Expert Review of Pharmacoeconomics & Outcomes Research, 2013Co-Authors: Richard C Van Kleef, Wynand P.m.m. Van De Ven, René C.j.a. Van VlietAbstract:The Dutch basic Health Insurance is based on the principles of regulated competition. This implies that insurers and providers compete on price and quality while the regulator sets certain rules to achieve public objectives such as solidarity. Two regulatory aspects of this scheme are that insurers are not allowed to risk rate their premiums and are compensated for predictable variation in individual medical expenses (i.e., risk equalization). Research, however, indicates that the current risk equalization is imperfect, which confronts insurers and consumers with incentives for risk selection. The goal of this paper is to review the concept, possibilities and potential effects of risk selection in the Dutch basic Health Insurance. We conclude that the possibilities for risk selection are numerous and a potential threat to solidarity, efficiency and quality of care. Regulators should be aware that measurement of risk selection is a methodological and data-demanding challenge.
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universal mandatory Health Insurance in the netherlands a model for the united states
Health Affairs, 2008Co-Authors: Wynand P.m.m. Van De Ven, Frederik T. SchutAbstract:Policy analysts consider the Netherlands Health system a possible model for the United States. Since 2006 all Dutch citizens have to buy standardized individual Health Insurance coverage from a private insurer. Consumers have an annual choice among insurers, and insurers can selectively contract or integrate with Health care providers. Subsidies make Health Insurance affordable for everyone. A Risk Equalization Fund compensates insurers for enrollees with predictably high medical expenses. The reform is a work in progress. So far the emphasis has been on the Health Insurance Market. The challenge is now to successfully reform the Market for the provision of Health care.
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risk adjustment and risk selection in europe 6 years later
Health Policy, 2007Co-Authors: Wynand P.m.m. Van De Ven, Konstantin Beck, Carine Van De Voorde, J Wasem, Irit ZmoraAbstract:In this paper we analyse the developments concerning risk adjustment and risk selection in Belgium, Germany, Israel, the Netherlands and Switzerland in the period 2000–2006. Since 2000 two major trends can be observed. On the one hand the risk adjustment systems have been improved, for example, by adding relevant Health-based risk adjusters. On the other hand in all five countries there is evidence of increasing risk selection, which increasingly becomes a problem, in particular in Germany and Switzerland. Some potential explanations are given for these seemingly contradictory observations. Since the mid-1990s citizens in these countries can regularly switch sickness fund, which should stimulate the sickness funds to improve efficiency in Health care production and to respond to consumers’ preferences. When looking at managed care there are some weak signals of increasing managed care activities by individual sickness funds in all countries (except Belgium). However, with imperfect risk adjustment, such as in Israel and Switzerland, insurers will integrate their managed care activities with their selection activities, which may have adverse effects for society, even if all insurers are equally successful in selection. The conclusion is that good risk adjustment is an essential pre-condition for reaping the benefits of a competitive Health Insurance Market. Without good risk adjustment the disadvantages of a competitive Insurance Market may outweigh its advantages.
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can supplementary Health Insurance be used as a tool for risk selection in basic Health Insurance evidence from the netherlands
2007Co-Authors: Erik Schut, Doeska De Bruijn, Wynand P.m.m. Van De VenAbstract:For more than a decade, mandatory basic Health Insurance in the Netherlands is offered by competing Health insurers. Health insurers have to charge community-rated premiums for a standardized benefits package and to accept all applicants. A risk equalization scheme has been introduced to reduce incentives for risk selection. Traditionally, more than 90 percent of the compulsorily insured population buys supplementary Health Insurance from the same insurer. For supplementary Health Insurance insurers are free to risk rate premiums, to differentiate the benefits package and to practice medical underwriting. Since basic and supplementary Health Insurance are sold as a joint product, insurers can use rate setting, benefits design and selective underwriting to select favorable risks with respect to basic Health Insurance. In our research we addressed two questions. First, we examined whether and how Health insurers can identify (un)favorable risk groups given the prevailing risk equalization scheme. Second, using data over the period 2004-2007, we investigate rate setting, benefits design and underwriting practices by Health insurers in the supplementary Health Insurance Market. We find that by using Health questionnaires insurers can easily identify applicants which are (un)profitable relative to the risk equalization scheme in basic Health Insurance. We also find that the use of supplementary Health Insurance as selection device decreased over time. This is surprising because the incentives for risk selection substantially increased as a result of much stronger price competition after the introduction of a new national Health Insurance scheme in 2006. The most likely explanation for this paradox is the changing role of consumer advocacy organizations, which have become increasingly active in monitoring and exposing Health insurers' risk selection strategies.
Thomas C Buchmueller - One of the best experts on this subject based on the ideXlab platform.
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Health Insurance reform and hmo penetration in the small group Market
Inquiry, 2005Co-Authors: Thomas C Buchmueller, Su LiuAbstract:This study uses data from several national employer surveys conducted between the late 1980s and the mid-1990s to investigate the effect of state-level underwriting reforms on HMO penetration in the small group Health Insurance Market. We identify reform effects by exploiting cross-state variation in the timing and content of reform legislation and by using mid-sized and large employers, which were not affected by the legislation, as within-state control groups. While it is difficult to disentangle the effect of state reforms from other factors affecting HMO penetration in the small group Markets, the results suggest a positive relationship between Insurance Market regulations and HMO penetration.
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Health Insurance reform and hmo penetration in the small group Market
Social Science Research Network, 2005Co-Authors: Thomas C Buchmueller, Su LiuAbstract:We use data from several national employer surveys conducted between the late 1980s and the mid-1990s to investigate the effect of state-level underwriting reforms on HMO penetration in the small-group Health Insurance Market. We identify reform effects by exploiting cross-state variation in the timing and content of reform legislation and by using mid-sized and large employers, which were not affected by the legislation, as within-state control groups. While it is difficult to disentangle the effect of state reforms from other factors affecting HMO penetration in the small group Markets, the results suggest a positive relationship between Insurance Market regulations and HMO penetration.
Frederik T. Schut - One of the best experts on this subject based on the ideXlab platform.
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premium levels and demand response in Health Insurance relative thinking and zero price effects
Journal of Economic Behavior and Organization, 2020Co-Authors: Ron Van Der Heijden, Rudy Douven, Thomas G Mcguire, Frederik T. SchutAbstract:Abstract In Health care systems with a competitive Health Insurance Market, governments or other sponsors (e.g. employers) often subsidize premiums to encourage enrolment. These subsidies are typically independent of plan choice leaving the absolute premium differences in place so as not to distort consumer choice of plan. Such subsidies do, however, change the relative premium differences across plans, which, according to theories from behavioral economics, can affect choice. Consumers might be sensitive to differences relative to a reference premium (“relative thinking”). Furthermore, consumers might be particularly sensitive to a reference premium of zero (“zero-price effect”), a relevant range for some subsidized Health Insurance Markets. This paper tests these ideas with two sources of evidence. We argue that observed equilibria in Germany and the U.S. Medicare Advantage Markets are consistent with a powerful zero-price effect, resulting in an equilibrium focal pricing at zero. This contrasts with the Netherlands where equilibrium premiums are well above zero. In an empirical test using hypothetical questions in a web-based survey in these three countries, we also find evidence for both a relative thinking and a zero-price effect in the demand for Health Insurance. Our findings imply that well-designed subsidies can leverage relative thinking to increase demand elasticity for Health plans. Creation of a powerful reference price (e.g., at zero), however, risks subverting price competition.
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universal mandatory Health Insurance in the netherlands a model for the united states
Health Affairs, 2008Co-Authors: Wynand P.m.m. Van De Ven, Frederik T. SchutAbstract:Policy analysts consider the Netherlands Health system a possible model for the United States. Since 2006 all Dutch citizens have to buy standardized individual Health Insurance coverage from a private insurer. Consumers have an annual choice among insurers, and insurers can selectively contract or integrate with Health care providers. Subsidies make Health Insurance affordable for everyone. A Risk Equalization Fund compensates insurers for enrollees with predictably high medical expenses. The reform is a work in progress. So far the emphasis has been on the Health Insurance Market. The challenge is now to successfully reform the Market for the provision of Health care.
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access to coverage for high risks in a competitive individual Health Insurance Market via premium rate restrictions or risk adjusted premium subsidies
Journal of Health Economics, 2000Co-Authors: Wynand P.m.m. Van De Ven, René C.j.a. Van Vliet, Frederik T. Schut, Erik M Van BarneveldAbstract:A competitive Market for individual Health Insurance tends to risk-adjusted premiums. Premium rate restrictions are often considered a tool to increase access to coverage for high-risk individuals in such a Market. However, such regulation induces selection which may have several adverse effects. As an alternative approach we consider risk-adjusted premium subsidies. Empirical results of simulated premium models and subsidy formulae are presented. It is shown that sufficiently adjusted subsidies eliminate the need for premium rate restrictions and consequently avoid their adverse effects. Therefore, the subsidy approach is the preferred strategy to increase access to coverage for high-risk individuals.
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Should catastrophic risks be included in a regulated competitive Health Insurance Market
Social Science & Medicine, 1994Co-Authors: Wynand P.m.m. Van De Ven, Frederik T. SchutAbstract:In 1988 the Dutch government launched a proposal for a national Health Insurance based on regulated competition. The mandatory benefits package should be offered by competing insurers and should cover both non-catastrophic risks (like hospital care, physician services and drugs) and catastrophic risks (like several forms of expensive long-term care). However, there are two arguments to exclude some of the catastrophic risks from the competitive Insurance Market, at least during the implementation process of the reforms. Firstly, the prospects for a workable system of risk-adjusted payments to the insurers that should take away the incentives for cream skimming are, at least during the next 5 years, more favorable for the non-catastrophic risks than for the catastrophic risks. Secondly, even if a workable system of risk-adjusted payments can be developed, the problem of quality skimping may be relevant for some of the catastrophic risks, but not for non-catastrophic risks. By 'quality skimping' we mean the reduction of the quality of care to a level which is below the minimum level that is acceptable to society. After 5 years of Health care reforms in the Netherlands new insights have resulted in a growing support to confine the implementation of the reforms to the non-catastrophic risks. In drawing (and redrawing) the exact boundaries between different regulatory regimes for catastrophic and non-catastrophic risks, the expected benefits of a cost-effective substitution of care have to be weighted against the potential harm caused by cream skimming and quality skimping.
Su Liu - One of the best experts on this subject based on the ideXlab platform.
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Health Insurance reform and hmo penetration in the small group Market
Inquiry, 2005Co-Authors: Thomas C Buchmueller, Su LiuAbstract:This study uses data from several national employer surveys conducted between the late 1980s and the mid-1990s to investigate the effect of state-level underwriting reforms on HMO penetration in the small group Health Insurance Market. We identify reform effects by exploiting cross-state variation in the timing and content of reform legislation and by using mid-sized and large employers, which were not affected by the legislation, as within-state control groups. While it is difficult to disentangle the effect of state reforms from other factors affecting HMO penetration in the small group Markets, the results suggest a positive relationship between Insurance Market regulations and HMO penetration.
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Health Insurance reform and hmo penetration in the small group Market
Social Science Research Network, 2005Co-Authors: Thomas C Buchmueller, Su LiuAbstract:We use data from several national employer surveys conducted between the late 1980s and the mid-1990s to investigate the effect of state-level underwriting reforms on HMO penetration in the small-group Health Insurance Market. We identify reform effects by exploiting cross-state variation in the timing and content of reform legislation and by using mid-sized and large employers, which were not affected by the legislation, as within-state control groups. While it is difficult to disentangle the effect of state reforms from other factors affecting HMO penetration in the small group Markets, the results suggest a positive relationship between Insurance Market regulations and HMO penetration.
Mark V Pauly - One of the best experts on this subject based on the ideXlab platform.
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limiting the tax exclusion for employmentbased Health Insurance are improved equity and efficiency enough
National Tax Journal, 2009Co-Authors: Mark V PaulyAbstract:Removal or limitation of the current exclusion of employment-related Health benefit payments from taxable income would improve economic efficiency and equity, but is this sufficient to make such a policy change likely? This paper uses some concepts from public choice theory, based on earlier work by Buchanan and Pauly on the incidence of tax deductibility, to suggest that such a change is more likely in the current context of broader tax reform involving a desire to reform the functioning of the Health Insurance Market and to increase the tax share of upper middle income households.
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risk pooling and regulation policy and reality in today s individual Health Insurance Market
Health Affairs, 2007Co-Authors: Mark V Pauly, Bradley HerringAbstract:Analysis of new data on the relationship between and premiums and coverage in the individual Insurance Market and Health risk shows that actual premiums paid for individual Insurance are much less than proportional to risk, and risk levels have a small effect on obtaining coverage. States limiting risk rating in individual Insurance display lower premiums for high risks than other states, but such rate regulation leads to an increase in the total number of uninsured people. The effect on risk pooling is small because of the large amount of risk pooling in unregulated individual Insurance.
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the effect of state community rating regulations on premiums and coverage in the individual Health Insurance Market
National Bureau of Economic Research, 2006Co-Authors: Bradley Herring, Mark V PaulyAbstract:Some states have implemented community rating regulations to limit the extent to which premiums in the individual Health Insurance Market can vary with a person?s Health status. Community rating and guaranteed issues laws were passed with hopes of increasing access to affordable Insurance for people with high-risk Health conditions, but there are concerns that these laws led to adverse selection. In some sense, the extent to which these regulations ultimately affected the individual Market depends in large part on the degree of risk segmentation in unregulated states. In this paper, we examine the relationship between expected medical expenses, individual Insurance premiums, and the likelihood of obtaining individual Insurance using data from both the National Health Interview Survey and the Community Tracking Study Household Survey. We test for differences in these relationships between states with both community rating and guaranteed issue and states with no such regulations. While we find that people living in unregulated states with higher expected expense due to chronic Health conditions pay modestly higher premiums and are somewhat less likely to obtain coverage, the variation between premiums and risk in unregulated individual Insurance Markets is far from proportional; there is considerable pooling. In regulated states, we find that there is no effect of having higher expected expense due to chronic Health conditions on neither premiums nor coverage. Overall, our results suggest that the effect of regulation is to produce a slight increase in the proportion uninsured, as increases in low risk uninsureds more than offset decreases in high risk uninsureds. Community rating and guaranteed issue regulations produce only small changes in risk pooling because the extent of pooling in the absence of regulation is substantial.
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the nongroup Health Insurance Market short on facts long on opinions and policy disputes
Health Affairs, 2002Co-Authors: Mark V Pauly, Len M NicholsAbstract:A roadmap through the areas of agreement and disagreement in a critical debate on how to solve the problem of too many uninsured Americans. by Mark V. Pauly and Len M. Nichols ABSTRACT: Individual Health Insurance is more administratively costly and more prone to adverse selection (especially in the presence of community rating) than group Health cover- age is. In this paper we show that the individual Market has been shrinking over time but that it might be stimulated if tax credits for such Insurance were made available. The pri- mary areas of factual disagreement have to do with the frequency with which individual in- surers charge some applicants higher premiums than others (based on Health risk), and the effect that premiums related to risk have on the likelihood of Insurance purchase at dif- ferent income levels. The primary area of policy disagreement concerns the value of offer- ing Insurance at lower premiums to higher risks relative to the value of making voluntary in- surance attractive to lower risks. We argue that a major Market failure for individual coverage may be caused by insurers' inability to distinguish some truly low risks. We con- clude that the individual Market works acceptably well for about 80 percent of potential buyers, but its performance for the remaining 20 percent of low-income or high-risk per- sons is controversial.
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premium variation in the individual Health Insurance Market
International Journal of Health Care Finance & Economics, 2001Co-Authors: Bradley Herring, Mark V PaulyAbstract:Recent proposals to decrease the number of uninsured in the U.S. indicate that the individual Health Insurance Market's role may increase. Amid fears of possible risk-segmentation in individual Insurance, there exists limited information of the functioning of such Markets. This paper examines the relationship between expected medical expense and actual paid premiums for households with individual Insurance in the 1996–1997 Community Tracking Study's Household Survey. We find that premiums vary less than proportionately with expected expense and vary only with certain risk characteristics. We also explore how the relationship between risk and premiums is affected by local regulations and Market characteristics. We find that premiums vary significantly less strongly with risk for persons insured by HMOs and in Markets dominated by managed care insurers.
