title: Demand-side strategies to deal with moral hazard in public insurance for long-term care.
abstract: Moral hazard in public insurance for long-term care may be counteracted by strategies influencing supply or demand. Demand-side strategies may target the patient or the insurer. Various demand-side strategies and how they are implemented in four European countries (Germany, Belgium, Switzerland and the Netherlands) are described, highlighting the pros and cons of each strategy. Patient-oriented strategies to counteract moral hazard are used in all four countries but their impact on efficiency is unclear and crucially depends on their design. Strategies targeted at insurers are much less popular: Belgium and Switzerland have introduced elements of managed competition for some types of long-term care, as has the Netherlands in 2015. As only some elements of managed competition have been introduced, it is unclear whether it improves efficiency. Its effect will depend on the feasibility of setting appropriate financial incentives for insurers using risk equalization and the willingness of governments to provide insurers with instruments to manage long-term care.
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands bakx@bmg.eur.nl.
authors.forename: Pieter
authors.initials: P
authors.lastname: Bakx
authors.affiliation: Ben Gurion University of the Negev, Taub Center for Social Policy, Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Chernichovsky
authors.affiliation: School of Management & Governance, Murdoch University, Australia; School of Economics, University of Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Paolucci
authors.affiliation: Department of Economics, Katholieke Universiteit Leuven, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Schokkaert
authors.affiliation: Polynomics, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Trottmann
authors.affiliation: Institute for Health Services Management, University of Duisburg-Essen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Wasem
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Schut
mesh_terms: D017598:Efficiency, Organizational; D005060:Europe; D015276:Health Care Rationing / Q000458:organization & administration; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration*; D008134:Long-Term Care / Q000191:economics*; D018854:Managed Competition / Q000191:economics / Q000458:organization & administration*; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D057766:Policy; D020379:Risk Adjustment; D012307:Risk Factors
keywords: long-term care; managed competition; public insurance; risk adjustment