Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, The Netherlands.
National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Med Care Res Rev. 2024 Jun;81(3):175-194. doi: 10.1177/10775587231222584. Epub 2024 Jan 29.
In health insurance markets with regulated competition, regulators face the challenge of preventing risk selection. This paper provides a framework for analyzing the scope (i.e., potential actions by insurers and consumers) and incentives for risk selection in such markets. Our approach consists of three steps. First, we describe four types of risk selection: (a) selection by consumers in and out of the market, (b) selection by consumers between high- and low-value plans, (c) selection by insurers via plan design, and (d) selection by insurers via other channels such as marketing, customer service, and supplementary insurance. In a second step, we develop a conceptual framework of how regulation and features of health insurance markets affect the scope and incentives for risk selection along these four dimensions. In a third step, we use this framework to compare nine health insurance markets with regulated competition in Australia, Europe, Israel, and the United States.
在具有监管竞争的医疗保险市场中，监管机构面临着防范风险选择的挑战。本文提供了一个分析框架，用于分析此类市场中风险选择的范围（即保险公司和消费者的潜在行为）和激励措施。我们的方法包括三个步骤。首先，我们描述了四种类型的风险选择：（a）消费者在市场内外的选择，（b）消费者在高价值和低价值计划之间的选择，（c）保险公司通过计划设计进行的选择，以及（d）保险公司通过营销、客户服务和补充保险等其他渠道进行的选择。在第二步中，我们制定了一个概念框架，说明监管和医疗保险市场的特征如何影响这四个方面的风险选择范围和激励措施。在第三步中，我们使用这个框架来比较澳大利亚、欧洲、以色列和美国的九个具有监管竞争的医疗保险市场。
