Fine Tuning of Health Insurance Regulation: Unhealthy Consequences for an Individual Insurer

Johannes Schoder (), Michele Sennhauser () and Peter Zweifel ()
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Johannes Schoder: Socioeconomic Institute, University of ZurichAuthor-Name: Michele Sennhauser
Michele Sennhauser: Socioeconomic Institute, University of Zurich
Peter Zweifel: Socioeconomic Institute, University of Zurich

No 916, SOI - Working Papers from Socioeconomic Institute - University of Zurich

Abstract: This paper sheds light on some unexpected consequences of health insurance regulation that may pose a big challenge to insurers� risk management. Because mandated uniform contributions to health insurance trigger risk selection efforts risk adjustment (RA) schemes become necessary. A good deal of research into the optimal RA formula has been performed (Ellis and Van de Ven [2000]). A recent proposal has been to add �Hospitalization exceeding three days during the previous year� as an indicator of high risk (Beck et al. [2006]). Applying the new formula to an individual Swiss health insurer, its payments into the RA scheme are postdicted to explode, reaching up to 13 percent of premium income. Its mistake had been to successfully implement Managed Care, resulting in low rates of hospitalization. The predicted risk management response is to extend hospital stays beyond three days, contrary to stated policy objectives also of the United States.

Keywords: Health insurance; regulation; risk adjustment; risk management (search for similar items in EconPapers)
JEL-codes: H51 I18 L51 (search for similar items in EconPapers)
Pages: 18 pages
Date: 2009-09
New Economics Papers: this item is included in nep-hea, nep-ias, nep-reg and nep-rmg
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Published in International Journal of the Economics of Business, 17(3), pp. 313-327, 2010

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