The Development of the Irish Private Health Insurance Market and Evidence of Selection Effects Therein (original) (raw)

Risk Equalisation and Competition in the Irish Health Insurance Market

Trinity Economics Papers, 2005

a market positive equalisation adjustment (MPEA) from BUPA Ireland to VHI of €16,715,770. Structure of this response. The structure of this response is as follows:-(A)Executive summary (B)Response to the YHEC report (C)Response to the HIA letter (D)Health Insurance and gains from competition (A) EXECUTIVE SUMMARY.

The market in Ireland for healthcare insurance

Open Access publications, 1998

The healthcare market in Ireland is facing a series of problems arising from the dual nature of the market. Health insurance is an important element of this dual market. Yet the main issues confronting the health insurance industry - the ageing of the population and medical inflation - have not produced a set of insurance products in response. Subscribers thus face continued increases in charges well above inflation and these increased charges could well adversely affect new membership of younger people. The introduction of competition has not resolved this issue. Instead, it has concentrated attention on measures to maintain the existing situation. Some of the institutions associataed with the regulatory environment, for example the Risk Equalisation Scheme, have their own problems; and while it is worthwhile to resolve them, it is more important to consider the long-term issues.

Adverse Selection and the Decline in Private Health Insurance Coverage in Australia: 1989-95

Economic Record, 2003

The decline in private health insurance coverage over the period 1989-1995 is analysed using the ABS National Health Surveys. Individual's health status and health risk behaviours are found to be significant determinants of their decision to purchase private health insurance. At a point in time, the pool of the insured is very heterogeneous, with a mix of both good and bad health risks. It is found that the decline in insurance coverage over the period 1989-95 coincided with an increase in the degree of 'adverse selection' within the insured population.

Testing for adverse selection into private medical insurance

2006

We develop a test for adverse selection and use it to examine private health insurance markets. In contrast to earlier papers that consider a purely private system or a system in which private insurance supplements a public system, we focus our attention on a system where privately funded health care is substitutive of the publicly funded one. Using a model

Who Took out Additional Supplementary Health Insurance? A dynamic Analysis of Adverse-Selection

I n s t i t u t e f o r R e s e a r c h a n d I n f o r m a t i o n i n H e a l t h E c o n o m i c s no 150-January 2010 According to economic theory, individuals choose their insurance cover levels in virtue of anticipated health expenditures. Thus, they partially reveal their health risks. Yet, on the French health insurance market this hypothesis, known as 'adverse-selection', has only been tested on the supplementary health insurance purchase decision. However, the supplementary health insurance market is extremely heterogeneous, at least in the same way as beneficiaries' health risk levels. Between July 1st 2003 and December 31st 2006, a mutual insurance fund for state employees (Mutuelle générale de l'équipement et des territoires) offered existing holders of its supplementary cover ('MGET basic') an additional health coverage ('MGET+'). This particular context, where individuals covered from the same supplementary health insurance decide to pu...

Statutory health insurance competition in Europe: A four-country comparison

Health Policy, 2013

This paper explores the goals and implementation of reforms introducing choice of and competition among insurers providing statutory health coverage in Belgium, Germany, the Netherlands and Switzerland. In theory, health insurance competition can enhance efficiency in health care administration and delivery only if people have free choice of insurer (consumer mobility), if insurers do not have incentives to select risks, and if insurers are able to influence health service quality and costs. In practice, reforms in the four countries have not always prioritised efficiency and implementation has varied. Differences in policy goals explain some but not all of the differences in implementation. Despite significant investment in risk adjustment, incentives for risk selection remain and consumer mobility is not evenly distributed across the population. Better risk adjustment might make it easier for older and less healthy people to change insurer. Policy makers could also do more to prevent insurers from linking the sale of statutory and voluntary health insurance, particularly where take-up of voluntary coverage is widespread. Collective negotiation between insurers and providers in Belgium, Germany and Switzerland curbs insurers' ability to influence health care quality and costs. Nevertheless, while insurers in the Netherlands have good access to efficiency-enhancing tools, data and capacity constraints and resistance from stakeholders limit the extent to which tools are used. The experience of these countries offers an important lesson to other countries: it is not straightforward to put in place the conditions under which health insurance competition can enhance efficiency. Policy makers should not, therefore, underestimate the challenges involved.

Prices Matter: Comparing Two Tests of Adverse Selection in Health Insurance

2012

A standard test for adverse selection in health insurance examines whether people with characteristics predicting high health care utilization are more likely to buy insurance (or buy more generous insurance). George Akerlof's theory of adverse selection suggests a test based on prices: those who purchase insurance at the regular price will have higher expected utilization than those buying insurance when offered a deeply discounted price. Both tests provide (different) lower bounds on self-selection. We use a randomly allocated coupon for deeply discounted health insurance in rural Cambodia coupled with a longitudinal survey to test for adverse selection. While the standard test can show only a small amount of self-selection, the Prices test shows vastly more self-selection-providing a much more informative lower bound.