Scope and incentives for risk selection in health insurance markets with regulated competition: a conceptual framework and international comparison
Date
2024-01-29
Authors
van Kleef, Richard C.
Reuser, Mieke
McGuire, Thomas G.
Armstrong, John
Beck, Konstantin
Brammli-Greenberg, Shuli
Ellis, Randall P.
Paolucci, Francesco
Schokkaert, Erik
Wasem, Juergen
Version
Published version
OA Version
Citation
R.C. van Kleef, M. Reuser, T.G. McGuire, J. Armstrong, K. Beck, S. Brammli-Greenberg, R.P. Ellis, F. Paolucci, E. Schokkaert, J. Wasem. 2024. "Scope and Incentives for Risk Selection in Health Insurance Markets With Regulated Competition: A Conceptual Framework and International Comparison." Medical Care Research and Review, pp.10775587231222584-. https://doi.org/10.1177/10775587231222584
Abstract
In health insurance markets with regulated competition, regulators face the challenge of preventing risk selection. This paper provides a framework for analyzing the scope (i.e., potential actions by insurers and consumers) and incentives for risk selection in such markets. Our approach consists of three steps. First, we describe four types of risk selection: (a) selection by consumers in and out of the market, (b) selection by consumers between high- and low-value plans, (c) selection by insurers via plan design, and (d) selection by insurers via other channels such as marketing, customer service, and supplementary insurance. In a second step, we develop a conceptual framework of how regulation and features of health insurance markets affect the scope and incentives for risk selection along these four dimensions. In a third step, we use this framework to compare nine health insurance markets with regulated competition in Australia, Europe, Israel, and the United States.
Description
License
© The Author(s) 2024. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage)