Institute of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Appl Health Econ Health Policy. 2004;3(4):229-41. doi: 10.2165/00148365-200403040-00006.
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.
20 世纪 90 年代，德国、荷兰、瑞士、比利时和以色列通过引入健康保险公司选择自由（开放式注册）对其社会健康保险计划进行了重大改革。与此同时，还建立了风险调整制度，以补偿承保人预测的高医疗费用的被保险人。尽管这些国家的健康保险改革具有相似性，但我们发现，这些改革背后的基本原理及其对消费者选择的影响差异很大。在本文中，我们试图通过对健康保险公司选择的潜在决定因素进行跨国比较，来解释观察到的转换率差异。我们的结论是，选择环境的差异以及转换的净收益差异为消费者流动性的巨大差异提供了合理的解释。最后，我们讨论了我们跨国比较的政策含义。我们认为，最优的转换率取决于改革的目标和风险调整系统的质量。有鉴于此，我们的结论是，目前荷兰的转换率太低，需要采取积极的政府政策来鼓励消费者流动。在德国和瑞士，较高的转换率需要改进相当不完善的风险调整系统。鉴于以色列和比利时的转换率较低，改善风险调整在短期内不太紧迫，但从长远来看仍有必要。
