Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
Health Policy. 2017 Oct;121(10):1085-1092. doi: 10.1016/j.healthpol.2017.08.003. Epub 2017 Aug 10.
Nearly everyone with a supplementary insurance (SI) in the Netherlands takes out the voluntary SI and the mandatory basic insurance (BI) from the same health insurer. Previous studies show that many high-risks perceive SI as a switching cost for BI. Because consumers' current insurer provides them with a guaranteed renewability, SI is a switching cost if insurers apply selective underwriting to new applicants. Several changes in the Dutch health insurance market increased insurers' incentives to counteract adverse selection for SI. Tools to do so are not only selective underwriting, but also risk rating and product differentiation. If all insurers use the latter tools without selective underwriting, SI is not a switching cost for BI. We investigated to what extent insurers used these tools in the periods 2006-2009 and 2014-2015. Only a few insurers applied selective underwriting: in 2015, 86% of insurers used open enrolment for all their SI products, and the other 14% did use open enrolment for their most common SI products. As measured by our indicators, the proportion of insurers applying risk rating or product differentiation did not increase in the periods considered. Due to the fear of reputation loss insurers may have used 'less visible' tools to counteract adverse selection that are indirect forms of risk rating and product differentiation and do not result in switching costs. So, although many high-risks perceive SI as a switching cost, most insurers apply open enrolment for SI. By providing information to high-risks about their switching opportunities, the government could increase consumer choice and thereby insurers' incentives to invest in high-quality care for high-risks.
几乎所有在荷兰拥有补充保险 (SI) 的人都从同一家健康保险公司购买自愿 SI 和强制性基本保险 (BI)。先前的研究表明，许多高风险人群认为 SI 是 BI 的转换成本。由于消费者当前的保险公司为他们提供了有保证的可续保性，如果保险公司对新申请人进行选择性承保，SI 就是一种转换成本。荷兰健康保险市场的几项变化增加了保险公司对 SI 进行逆向选择的激励。实现这一目标的工具不仅是选择性承保，还包括风险评级和产品差异化。如果所有保险公司在没有选择性承保的情况下都使用后两种工具，那么 SI 就不是 BI 的转换成本。我们调查了在 2006-2009 年和 2014-2015 年期间，保险公司在多大程度上使用了这些工具。只有少数几家保险公司采用了选择性承保：2015 年，86%的保险公司对其所有 SI 产品都采用了开放式注册，其余 14%的保险公司对其最常见的 SI 产品采用了开放式注册。根据我们的指标衡量，在考虑的时期内，采用风险评级或产品差异化的保险公司比例没有增加。由于担心声誉受损，保险公司可能会使用“不太明显”的工具来防范逆向选择，这些工具是风险评级和产品差异化的间接形式，不会导致转换成本。因此，尽管许多高风险人群认为 SI 是一种转换成本，但大多数保险公司都对 SI 采用开放式注册。政府向高风险人群提供有关其转换机会的信息，可以增加消费者的选择，从而增加保险公司为高风险人群提供高质量护理的激励。
