title: Risk equalization and voluntary deductibles: a complex interaction.
abstract: The presence of voluntary deductibles in the Swiss and Dutch mandatory health insurance has important implications for the respective risk equalization systems. In a theoretical analysis, we discuss the consequences of equalizing three types of expenditures: the net claims that are reimbursed by the insurer, the out-of-pocket expenditures and the expenditure savings due to moral hazard reduction. Equalizing only the net claims, as done in Switzerland, creates incentives for cream skimming and prevents insurers from incorporating out-of-pocket expenditures and moral hazard reductions into their premium structure. In an empirical analysis, we examine the effect of self-selection and conclude that the Swiss and Dutch risk equalization systems do not fully adjust for differences in health status between those who choose a deductible and those who do not. We discuss how this may lead to incentives for cream skimming and to a reduction of cross-subsidies from healthy to unhealthy individuals compared to a situation without voluntary deductibles.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands. vankleef@bmg.eur.nl
authors.forename: R C
authors.initials: RC
authors.lastname: van Kleef
authors.forename: K
authors.initials: K
authors.lastname: Beck
authors.forename: W P M M
authors.initials: WP
authors.lastname: van de Ven
authors.forename: R C J A
authors.initials: RC
authors.lastname: van Vliet
mesh_terms: D019992:Databases as Topic; D003669:Deductibles and Coinsurance; D005382:Financing, Personal; D005102:Health Expenditures; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D009426:Netherlands; D020414:Risk Sharing, Financial; D013222:State Medicine / Q000191:economics; D013557:Switzerland