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Statutory health insurance competition in Europe: a four-country comparison

Thomson, Sarah, Busse, Reinhard, Crivelli, Luca, van de Ven, Wynand and Van de Voorde, Carine (2013) Statutory health insurance competition in Europe: a four-country comparison. Health Policy, 109 (3). pp. 209-225. ISSN 0168-8510

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Identification Number: 10.1016/j.healthpol.2013.01.005


This paper explores the goals and implementation of reforms introducing choice of and competition among insurers providing statutory health coverage in Belgium, Germany, the Netherlands and Switzerland. In theory, health insurance competition can enhance efficiency in health care administration and delivery only if people have free choice of insurer (consumer mobility), if insurers do not have incentives to select risks, and if insurers are able to influence health service quality and costs. In practice, reforms in the four countries have not always prioritised efficiency and implementation has varied. Differences in policy goals explain some but not all of the differences in implementation. Despite significant investment in risk adjustment, incentives for risk selection remain and consumer mobility is not evenly distributed across the population. Better risk adjustment might make it easier for older and less healthy people to change insurer. Policy makers could also do more to prevent insurers from linking the sale of statutory and voluntary health insurance, particularly where take-up of voluntary coverage is widespread. Collective negotiation between insurers and providers in Belgium, Germany and Switzerland curbs insurers’ ability to influence health care quality and costs. Nevertheless, while insurers in the Netherlands have good access to efficiency-enhancing tools, data and capacity constraints and resistance from stakeholders limit the extent to which tools are used. The experience of these countries offers an important lesson to other countries: it is not straightforward to put in place the conditions under which health insurance competition can enhance efficiency. Policy makers should not, therefore, underestimate the challenges involved.

Item Type: Article
Official URL:
Additional Information: © 2013 Elsevier Ireland Ltd.
Divisions: Social Policy
LSE Health
Subjects: R Medicine > RA Public aspects of medicine
Date Deposited: 03 Jun 2013 09:08
Last Modified: 16 May 2024 01:39
Funders: Commonwealth Fund

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