Bes Romy E, Curfs Emile C, Groenewegen Peter P, de Jong Judith D
1Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124,3513 CR,Utrecht,The Netherlands.
2Open University,Valkenburgerweg 177,6419 AT,Heerlen,The Netherlands.
Health Econ Policy Law. 2017 Jul;12(3):345-362. doi: 10.1017/S1744133116000517. Epub 2017 Mar 14.
In a health care system based on managed competition, health insurers negotiate on quality and price with care providers and are allowed to offer restrictive health plans. It is crucial that enrolees who need care choose restrictive health plans, as otherwise health insurers cannot channel patients to contracted providers and they will lose their bargaining power in negotiations with providers. We aim to explain enrolees' choice of a restrictive health plan in exchange for a lower premium. In 2014 an online survey with an experimental design was conducted on members of an access panel (response 78%; n=3,417). Results showed 37.4% of respondents willing to choose a restrictive health plan in exchange for a lower premium. This fell to 22% when the restrictive health plan also included a longer travelling time. Enrolees who choose a restrictive health plan are younger and healthier, or on lower incomes, than those preferring a non-restrictive one. This means that enrolees who use care will be unlikely to choose a restrictive health plan and, therefore, health insurers will not be able to channel them to contracted care providers. This undermines the goals of the health care system based on managed competition.
在基于管理式竞争的医疗保健系统中，健康保险公司与医疗服务提供者就质量和价格进行谈判，并被允许提供限制性健康计划。关键在于，需要医疗服务的参保人选择限制性健康计划，否则健康保险公司无法将患者引导至签约的医疗服务提供者处，并且会在与医疗服务提供者的谈判中失去议价能力。我们旨在解释参保人选择限制性健康计划以换取较低保费的原因。2014年，针对一个访问小组的成员进行了一项具有实验设计的在线调查（回复率78%；n = 3417）。结果显示，37.4%的受访者愿意选择限制性健康计划以换取较低保费。当限制性健康计划还包括更长的出行时间时，这一比例降至22%。选择限制性健康计划的参保人比那些倾向于非限制性健康计划的参保人更年轻、更健康或收入更低。这意味着使用医疗服务的参保人不太可能选择限制性健康计划，因此，健康保险公司将无法将他们引导至签约的医疗服务提供者处。这破坏了基于管理式竞争的医疗保健系统的目标。
