title: What health plans do people prefer? The trade-off between premium and provider choice.
abstract: Within a healthcare system with managed competition, health insurers are expected to act as prudent buyers of care on behalf of their customers. To fulfil this role adequately, understanding consumer preferences for health plan characteristics is of vital importance. Little is known, however, about these preferences and how they vary across consumers. Using a discrete choice experiment (DCE) we quantified trade-offs between basic health plan characteristics and analysed whether there are differences in preferences according to age, health status and income. We selected four health plan characteristics to be included in the DCE: (i) the level of provider choice and associated level of reimbursement, (ii) the primary focus of provider contracting (price, quality, social responsibility), (iii) the level of service benefits, and (iv) the monthly premium. This selection was based on a literature study, expert interviews and focus group discussions. The DCE consisted of 17 choice sets, each comprising two hypothetical health plan alternatives. A representative sample (n = 533) of the Dutch adult population, based on age, gender and educational level, completed the online questionnaire during the annual open enrolment period for 2015. The final model with four latent classes showed that being able to choose a care provider freely was by far the most decisive characteristic for respondents aged over 45, those with chronic conditions, and those with a gross income over €3000/month. Monthly premium was the most important choice determinant for young, healthy, and lower income respondents. We conclude that it would be very unlikely for half of the sample to opt for health plans with restricted provider choice. However, a premium discount up to €15/month by restricted health plans might motivate especially younger, healthier, and less wealthy consumers to choose these plans.
authors.affiliation: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Domino
authors.initials: D
authors.lastname: Determann
authors.affiliation: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: mattijs.lambooij@rivm.nl.
authors.forename: Mattijs S
authors.initials: MS
authors.lastname: Lambooij
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Esther W
authors.initials: EW
authors.lastname: de Bekker-Grob
authors.affiliation: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Tranzo - Scientific Center for Care and Welfare, Tilburg, The Netherlands.
authors.forename: Arthur P
authors.initials: AP
authors.lastname: Hayen
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Varkevisser
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
authors.forename: Frederik T
authors.initials: FT
authors.lastname: Schut
authors.affiliation: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: G Ardine de
authors.initials: GA
authors.lastname: Wit
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002755:Choice Behavior; D003258:Consumer Behavior / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000145:classification / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D020403:Patient Freedom of Choice Laws / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Discrete choice experiment (DCE); Free provider choice; Health plan choice; Latent class analysis; Managed competition; Stated preferences; The Netherlands; Willingness-to-pay (WTP)