The influence of supplementary health insurance on switching behaviour: evidence from Swiss data.

This paper focuses on the switching behaviour of enrolees in the Swiss basic health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there is limited evidence of premium convergence within cantons. This indicates that competition has not been effective so far, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of supplementary insurance. We use survey data on health plan choice (a sample of 1943 individuals whose switching behaviours were observed between 1997 and 2000) as well as administrative data relative to all insurance companies that operated in the 26 Swiss cantons between 1996 and 2005. The decision to switch and the decision to subscribe to a supplementary contract are jointly estimated.Our findings show that holding a supplementary insurance contract substantially decreases the propensity to switch. However, there is no negative impact of supplementary insurance on switching when the individual assesses his/her health as 'very good'. Our results give empirical support to one possible mechanism through which supplementary insurance might influence switching decisions: given that subscribing to basic and supplementary contracts with two different insurers may induce some administrative costs for the subscriber, holding supplementary insurance acts as a barrier to switch if customers who consider themselves 'bad risks' also believe that insurers reject applications for supplementary insurance on these grounds. In comparison with previous research, our main contribution is to offer a possible explanation for consumer inertia. Our analysis illustrates how consumer choice for one's basic health plan interacts with the decision to subscribe to supplementary insurance.

Self-selection and risk selection on the Swiss health insurance market

Abstract This thesis presents three empirical studies in the field of health insurance in Switzerland. First we investigate the link between health insurance coverage and health care expenditures. We use claims data for over 60 000 adult individuals covered by a major Swiss Health Insurance Fund, followed for four years; the data show a strong positive correlation between coverage and expenditures. Two methods are developed and estimated in order to separate selection effects (due to individual choice of coverage) and incentive effects ("ex post moral hazard"). The first method uses the comparison between inpatient and outpatient expenditures to identify both effects and we conclude that both selection and incentive effects are significantly present in our data. The second method is based on a structural model of joint demand of health care and health insurance and makes the most of the change in the marginal cost of health care to identify selection and incentive effects. We conclude that the correlation between insurance coverage and health care expenditures may be decomposed into the two effects: 75% may be attributed to selection, and 25 % to incentive effects. Moreover, we estimate that a decrease in the coinsurance rate from 100% to 10% increases the marginal demand for health care by about 90% and from 100% to 0% by about 150%. Secondly, having shown that selection and incentive effects exist in the Swiss health insurance market, we present the consequence of this result in the context of risk adjustment. We show that if individuals choose their insurance coverage in function of their health status (selection effect), the optimal compensations should be function of the se- lection and incentive effects. Therefore, a risk adjustment mechanism which ignores these effects, as it is the case presently in Switzerland, will miss his main goal to eliminate incentives for sickness funds to select risks. Using a simplified model, we show that the optimal compensations have to take into account the distribution of risks through the insurance plans in case of self-selection in order to avoid incentives to select risks.Then, we apply our propositions to Swiss data and propose a simple econometric procedure to control for self-selection in the estimation of the risk adjustment formula in order to compute the optimal compensations.

Consumer Advisory: Navigating the New Health Insurance Marketplace, September 2013

The Attorney General���s Consumer Protection Division receives hundreds of calls and consumer complaints every year. Follow these tips to avoid unexpected expense and disappointments. This record is about: Navigating the New Health Insurance Marketplace

Rethinking Health Insurance, Iowa State Planning Guide, September 30, 2005

Iowa has been a HRSA State Planning Grant participant since October 2000. Iowa���s purpose in participating in the program has remained constant: to identify, through research, policies that will help expand access to affordable health insurance coverage for all Iowans. The Iowa State Planning Grant project (Iowa-SPG) has been able to serve as a significant state data resource on the uninsured in Iowa throughout its tenure. Through the use of State Planning Grant resources, policymakers, the media, and interested citizens have been able to access, from one convenient and trusted source, a variety of information on Iowa���s uninsured population. Section 1 of this report presents an update of state-level data on the uninsured with a focus on the data that has been of greatest interest to various Iowa constituencies during the State Planning Grant years, 2001-2005.

A guide to understanding the variation in premiums in rural health insurance marketplaces (RUPRI Center for Rural Health Policy Analysis rural policy brief)

This brief discusses several important factors that should be considered when comparing health insurance plans in the health insurance marketplaces across geographic areas.

High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage.

OBJECTIVE: To investigate the determinants and the 4-year evolution of the forgoing of healthcare for economic reasons in Switzerland. METHOD: Population-based survey (2007-2010) of a representative sample aged 35-74years in the Canton of Geneva, Switzerland. Healthcare forgone, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. RESULTS: A total of 2601 subjects were included in the analyses. Of the subjects, 13.8% (358/2601) reported having forgone healthcare for economic reasons, with the percentage varying from 3.7% in the group with a monthly income &#8805;13,000CHF (1CHF&#8776;1$) to 30.9% in the group with a monthly income <3000CHF. In subjects with a monthly income <3000CHF, the percentage who had forgone healthcare increased from 22.5% in 2007/8 to 34.7% in 2010 (P trend=0.2). Forgoing healthcare for economic reasons was associated with lower income, female gender, smoking status, lower job position, having dependent children, being divorced and single, paying a higher deductible, and receiving a premium subsidy. CONCLUSION: In a Swiss region with universal health insurance coverage, the reported prevalence of forgoing healthcare for economic reasons was high and greatly dependent on socioeconomic factors. Our data suggested an increasing trend among participants with the lowest income.

Determinants of Consumer Purchase Decisions of Health Insurance in Kerala

This research work was to study the level of awareness of consumers about health insurance concept and market, consumer perceptions about health insurance providers, schemes and various factors that influence buying decision of health insurance. There is need to bring entire age group ��� high risk and low risk under health insurance cover. Widening the cover of health insurance calls for indepth understanding of consumer thinking and extensive marketing efforts based on that. Hence the study of consumer perceptions and the impact of different contributing factors on consumer purchase decision assume significance to the marketer. Understanding the consumer thinking on health insurance will also be of relevance to governmental/non governmental agencies, as affordable health care to all is a policy objective of the government and new schemes are being launched in this area.

Identifying job skills in commercial advisors in a health insurance company

The aim of this research was to identify the criticalcompetence of success of the commercial adviserin a company providing insurance and health services.For this research a sample of 34 commercialadvisers. The sample was divided into four groups(two per product and two per criterion of success).Systematic��fi eld observations, interviews of criticalincidents, application of response tests and salesworkshops were used to evaluate the differentialcompetences that the successful advisers wereshowing in relation to the advisers de��fi ned as average.The success criteria were based on the generatedcommission performance over the 10 months. Allin all, signi��fi cant differences were found betweenthe ���successful��� and ���average��� groups. Furthermore,competences that correlate positively with atop sales performance were observed and competencesthat have major level of discrimination betweenthe ���successful��� and ���average��� groups wereestablished. Orientation to achievement, planningand management, information search, commercialaggressiveness and strategic vision are the competencesthat were considered to be key in the topperformance of a sales agent or commercial adviser.Additionally, the results in the response testswere analyzed in the four study groups, withoutobserving signi��fi cant differences between them,which supports the theoretical framework of thepresent study.

Financial protection for the poor in Colombia: the effects of a subsidized health insurance scheme

Financial protection is one of the objectives of health systems, which protects poor households from falling into poverty as a result of health care related expenses. Expanding prepayment schemes to the poor is difficult in developing countries because labor is largely informal. Providing health care free-at-point-of-service does not adequately target spending on the poorest, but occupation- or community-based schemes have also inherent limitations to achieve universal coverage. Colombia adopted a government-subsidized health insurance scheme (SHI) strategy. The political debate about increasing SHI enrollment needs evidence about the effectiveness of this scheme regarding financial protection. This study runs a four-part model to estimate the effect of SHI on out-of-pocket expenses by the poor that are currently uninsured, if they were enrolled in the SHI. The results show a 43% and 50% reduction in expenses at Bogot�� and national level respectively, which confirms the effectiveness of SHI as a financial protection tool.

Health insurance as a strategy for access : Streamlined facts of the Colombian Health Care Reform

La reforma colombiana al sistema de salud (Ley 100 de 1993) estableci��, como estrategia para facilitar el acceso, la universalidad de un seguro de salud que se adquiere mediante la cotizaci��n en el r��gimen contributivo o mediante la afiliaci��n gratuita al r��gimen subsidiado, con la meta de cubrir a toda la poblaci��n con un plan de beneficios ��nico que comprende servicios de todos los niveles de atenci��n. En el documento se analizan los principales hechos estilizados de la reforma en cuanto a cobertura del seguro y acceso y, mediante modelos logit, se estiman los determinantes de la afiliaci��n y del acceso, con datos de las encuestas de calidad de vida de 1997 y 2003. Se destaca que la cobertura pas�� del 20% de la poblaci��n en 1993 al 60% en 2004, aunque parece imposible alcanzar la universalidad; la estructura y evoluci��n de la cobertura muestran que los dos reg��menes son complementarios, de modo que mientras el contributivo tiene mayor presencia en las ciudades y entre la poblaci��n con empleo formal, el subsidiado tiene mayor peso entre la poblaci��n rural y con bajos niveles de ingresos; por otra parte, el seguro tiene ventajas para la poblaci��n subsidiada, con una mayor probabilidad de utilizaci��n de servicios, aunque el plan es inferior al del contributivo y existen barreras para el acceso.

Biased selection within the social health insurance market in Colombia

Las regulaciones como primaje comunitario, paquetes estandarizados y afiliaci��n abierta, orientadas a reducir el impacto de las fallas en los mercados de seguros, tienen un efecto limitado puesto que abren espacio a la selecci��n sesgada. A partir de 1993, el sistema de seguridad social en salud en Colombia fue reformado hacia un enfoque de mercado con la expectativa de mejorar el desempe��o de los monopolios preexistentes exponi��ndolos a la competencia de nuevos entrantes. La hip��tesis que se maneja en el trabajo es que las fallas de mercado pueden llevar a selecci��n sesgada favoreciendo a los nuevos entrantes. Se analizaron dos encuestas de hogares utilizando el estado de salud auto reportado y la presencia de enfermedad cr��nica como indicadores prospectivos del riesgo de los afiliados. Se encuentra que hay selecci��n sesgada, llevando a selecci��n adversa entre los aseguradores preexistentes, y a selecci��n favorable entre los nuevos entrantes. Este patr��n se observa en 1997 y se incrementa en el 2003. Aunque las entidades preexistentes son entidades p��blicas, y su tama��o disminuy�� sustancialmente entre estos a��os, se analizan sus implicaciones fiscales en t��rminos de financiaci��n adicional por parte del gobierno.