Erasmus University Rotterdam, Rotterdam, Netherlands.
Med Care Res Rev. 2020 Dec;77(6):584-595. doi: 10.1177/1077558719825982. Epub 2019 Feb 1.
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 ( = 16.8 million) and survey information ( = 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.
本文分析了荷兰基本医疗保险市场中保险公司的选择激励机制，该市场采用社区定价保费和复杂的风险调整。选择激励机制源于三个市场特征的相互作用：保险公司的可能行动、消费者对这些行动的反应以及保险合同盈利能力的可预测变化。在对前两个特征进行定性分析之后，我们的主要目标是确定第三个特征。我们使用索赔数据（=1680 万）和调查信息（=387195）的组合，发现盈利能力存在可观的可预测变化。平均而言，健康状况良好的人是盈利的，而健康状况不佳的人则是亏损的。我们得出结论，荷兰保险公司确实面临选择激励。然而，选择激励的完整衡量标准捕捉到了个体层面盈利能力和消费者对保险公司行动的反应之间的相关性。深入了解这种相关性是进一步研究的一个重要方向。
