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首页> 美国卫生研究院文献>Springer Open Choice >How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence
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How can the regulator show evidence of (no) risk selection in health insurance markets? Conceptual framework and empirical evidence

机译：监管者如何在健康保险市场中显示出（无）风险选择的证据？概念框架和经验证据

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If consumers have a choice of health plan, risk selection is often a serious problem (e.g., as in Germany, Israel, the Netherlands, the United States of America, and Switzerland). Risk selection may threaten the quality of care for chronically ill people, and may reduce the affordability and efficiency of healthcare. Therefore, an important question is: how can the regulator show evidence of (no) risk selection? Although this seems easy, showing such evidence is not straightforward. The novelty of this paper is two-fold. First, we provide a conceptual framework for showing evidence of risk selection in competitive health insurance markets. It is not easy to disentangle risk selection and the insurers’ efficiency. We suggest two methods to measure risk selection that are not biased by the insurers’ efficiency. Because these measures underestimate the true risk selection, we also provide a list of signals of selection that can be measured and that, in particular in combination, can show evidence of risk selection. It is impossible to show the absence of risk selection. Second, we empirically measure risk selection among the switchers, taking into account the insurers’ efficiency. Based on 2-year administrative data on healthcare expenses and risk characteristics of nearly all individuals with basic health insurance in the Netherlands (N > 16 million) we find significant risk selection for most health insurers. This is the first publication of hard empirical evidence of risk selection in the Dutch health insurance market.
机译：如果消费者可以选择健康计划，则风险选择通常是一个严重的问题（例如，在德国，以色列，荷兰，美利坚合众国和瑞士）。风险选择可能会威胁到慢性病患者的护理质量，并可能降低医疗服务的负担能力和效率。因此，一个重要的问题是：监管机构如何显示（无）风险选择的证据？尽管这似乎很容易，但是显示这样的证据并不容易。本文的新颖性有两个方面。首先，我们提供了一个概念框架来显示竞争性健康保险市场中风险选择的证据。区分风险选择和保险公司的效率并不容易。我们建议采用两种方法来衡量风险选择，这些方法应不受保险公司效率的影响。因为这些措施低估了真正的风险选择，所以我们还提供了可以测量的选择信号列表，尤其是组合在一起时，可以显示风险选择的证据。无法证明没有风险选择。其次，我们根据保险公司的效率，以经验的方式衡量转换者之间的风险选择。根据有关荷兰几乎所有拥有基本医疗保险的个人（> 1600万）的医疗保健费用和风险特征的2年管理数据，我们发现大多数医疗保险公司都选择了重大风险。这是荷兰健康保险市场上关于风险选择的可靠经验证据的第一本出版物。

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