Ein Zweigleichungssystem wird simultan geschätzt. Wir nutzen Daten des Sozio-Oekonomischen Panels (SOEP), um diese Wechselbewegungen für den Zeitraum von 19 zu analysieren.
Aufgrund ihrer niedrigen Beitragssätze konnten die Betriebskrankenkassen eine Vielzahl neuer Mitglieder gewinnen. Um Adverse Selektion zu verhindern wurde 1994 ein prospektiver Risikostrukturausgleich eingeführt. In der Gesetzlichen Krankenversicherung wurde 1996 Wettbewerb zwischen den Krankenkassen eingeführt. This observation provides evidence for the standard Rothschild-Stiglitz separating equilibrium. Consequently, the comparative advantages of company-based funds will increase over time.
Thus the risk compensation scheme does not fully control for the health status of the changers. By estimating a simultaneous two equation system, we find that health status positively, and significantly, affects the probability of changing to a company-based sickness fund, especially after controlling for age. We analyze – using data from the German Socio- Economic Panel – the determinants of these transitions from 1995 to 2000. Due to their low contribution rates, company-based sickness funds were able to attract a lot of new members. To avoid adverse selection, a prospective risk compensation scheme was introduced in 1994. The German statutory health insurance market was exposed to competition in 1996. Given low switching rates in Israel and Belgium, improving risk adjustment is less urgent, but still required in the long run. In Germany and Switzerland, high switching rates call for an improvement of the rather poor risk-adjustment systems. In view of this, we conclude that switching rates are currently too low in the Netherlands, and an active government policy to encourage consumer mobility seems warranted. We argue that the optimal switching rate crucially depends on the goals of the reforms and the quality of the risk-adjustment system. We conclude that differences in choice setting, and in the net benefits of switching, offer a plausible explanation for the large differences in consumer mobility.Finally, we discuss the policy implications of our cross-country comparison. Despite the similarity in the health insurance reforms in these countries, we find that both the rationale behind these reforms and their impact on consumer choice vary widely.In this article we seek to explain the observed variation in switching rates by cross-country comparison of the potential determinants of health insurer choice. This was introduced alongside a system of risk adjustment to compensate health insurers for enrolees with predictable high medical expenses. The immediate future of health-care reform will concern the mode of financing of the SHI which centres on the question if contributions proportional to income shall be maintained or if there shall be a radical shift towards flat-rate health premiums.ĭuring the 1990s, the social health insurance schemes of Germany, the Netherlands, Switzerland, Belgium and Israel were significantly reformed by the introduction of freedom of choice (open enrolment) of health insurer. These two strands of reforms also affected the incentive structures for both insurers and providers in various ways which this article describes. Besides cost containment another leitmotif of reform have been attempts to increase competition both between sickness funds and providers of care. So far these measures did not have a negative effect on broad outcome measures such as life expectancy, which continued to rise, and self-assessed health of the population, which remained stable in the period 1992-2002. The primary measures to do this have been the introduction of budgets and a shift of expenditure towards private households mainly in the form of benefit exclusions and increased co-payments. The primary goal of health-care reforms since the 1990s has been to contain the expenditure of the SHI. Coverage of the SHI has remained fairly constant at about 90% whereas the rest of the population is insured for the most part with private health insurance. The core of the German health-care system is the statutory health insurance (SHI).
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