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Selection Incentives for Health Insurers in the Presence of Sophisticated Risk Adjustment



Selection Incentives for Health Insurers in the Presence of Sophisticated Risk Adjustment



Medical Care Research and Review 2019: 1077558719825982



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 ( N = 16.8 million) and survey information ( N = 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.

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Accession: 066446447

Download citation: RISBibTeXText

PMID: 30704337

DOI: 10.1177/1077558719825982


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