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Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets

Francesco Paolucci (), Erik Schut, Konstantin Beck, Stefan Greãÿ, Carine van de Voorde and Irit Zmora

Health Economics, Policy and Law, 2007, vol. 2, issue 2, 173-192

Abstract: As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

Date: 2007
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