title: Potential determinants of deductible uptake in health insurance: How to increase uptake in The Netherlands?
abstract: In health insurance, voluntary deductibles are offered to the insured in return for a premium rebate. Previous research has shown that 11 % of the Dutch insured opted for a voluntary deductible (VD) in health insurance in 2014, while the highest VD level was financially profitable for almost 50 % of the population in retrospect. To explain this discrepancy, this paper identifies and discusses six potential determinants of the decision to opt for a VD from the behavioral economic literature: loss aversion, risk attitude, ambiguity aversion, debt aversion, omission bias, and liquidity constraints. Based on these determinants, five potential strategies are proposed to increase the number of insured opting for a VD. Presenting the VD as the default option and providing transparent information regarding the VD are the two most promising strategies. If, as a result of these strategies, more insured would opt for a VD, moral hazard would be reduced.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands. vanwinssen@bmg.eur.nl.
authors.forename: K P M
authors.identifier: http://orcid.org/0000-0002-7528-0495
authors.initials: KP
authors.lastname: van Winssen
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
authors.forename: R C
authors.initials: RC
authors.lastname: van Kleef
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
authors.forename: W P M M
authors.initials: WP
authors.lastname: van de Ven
mesh_terms: D003258:Consumer Behavior; D003657:Decision Making; D003669:Deductibles and Coinsurance / Q000191:economics*; D005382:Financing, Personal / Q000191:economics*; D005102:Health Expenditures; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D037141:Mandatory Programs; D009426:Netherlands; D017149:Private Sector; D012306:Risk
keywords: Behavioral economics; Health insurance; Moral hazard; Nudge theory; Prospect theory; Voluntary deductibles