Hostname: page-component-cd4964975-ppllx Total loading time: 0 Render date: 2023-03-30T01:20:40.305Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets

Published online by Cambridge University Press:  01 April 2007

Department of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
Department of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
CSS Insurance and University of Zurich, Switzerland
Department of Health Sciences, University of Applied Sciences Fulda, Germany
Centre for Economic Studies, Catholic University Leuven, Belgium
Clalit Health Services, Israel
*Corresponding author: Francesco Paolucci, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Tel: +31 10 408 8535; E-mail:


As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Andersen, H.H. and Grabka, M.M. (2006), ‘Kassenwechsel in der GKV 1997–2004: Profile – Trends – Perspektiven’, in Göpffarth, D.Greß, S.Jacobs, K. and Wasem, J. (eds), Jahrbuch Risikostrukturausgleich 2006 – Zehn Jahre Kassenwahlfreiheit, St. Augustin: Asgard Verlag, pp. 145–189.Google Scholar
Beobachter, Kompakt (2006), Krankenkassen, Der Schweizerische Beobachter, 80(21),special issue, Scholar
Beck, K., Spycher, S.Holly, A. and Gardiol, L.(2003), ‘Risk adjustment in Switzerland’, Health Policy, 65(1): 6374.CrossRefGoogle Scholar
Beck, K. (2004),‘Risiko Krankenversicherung – Risikomanagement in einem regulierten Krankenversicherungsmarkt’, Haupt, Bern.Google Scholar
Beck, K. (2006), ‘Risk-adjustment and its impact on selection and efficiency: social health insurer’s strategic decision making’, presented at the European Conference on Health Economics, Budapest.Google Scholar
Berghman, J. and Meerbergen, E.(2005), ‘Aanvullende sociale voorzieningen in de tweede en derde pijler’, research project AG/01/084, CESO, Leuven.Google Scholar
Brammli-Greenberg, S. and Gross, R.(2003), ‘The private health insurance market in Israel’, JDC-Brookdale Institute.Google Scholar
Bruijn, D. de, Prinsze, F.J.Schut, F.T. and van de Ven, W.P.M.M.(2005), ‘Monitor Risicoselectie’, report for the NPCF, Erasmus University Rotterdam.Google Scholar
Bruijn, D. de and Schut, F.T.(2006), ‘Evaluatie aanvullende verzekeringen 2006’, report for the NPCF, Erasmus University Rotterdam.Google Scholar
Buchner, F. and Wasem, J.(2003), ‘Needs for further improvement: risk adjustment in the German health insurance system’, Health Policy, 65(1): 2135.CrossRefGoogle Scholar
Christian Mutualities (2003), ‘Resultaten CM-enquête’, CM-informatie (June), 18–26.Google Scholar
Colombo, F. (2001), ‘Towards more choice in social protection? Individual choice of insurer in basis mandatory health insurance in Switzerland’, Occasional papers No 53, Paris: OECD.Google Scholar
Colombo, F. and Tapay, N. (2004), ‘Private health insurance in OECD countries’, The OECD Health Project, Paris: OECD.CrossRefGoogle Scholar
Controledienst (2004), ‘Jaarverslag 2004, Controledienst voor de ziekenfondsen en de landsbonden van ziekenfondsen’, Brussel.Google Scholar
Cutler, D.M. and Reber, S.J.(1998), ‘Paying for health insurance: the trade-off between competition and adverse selection’, Quarterly Journal of Economics, 113(2): 433466.CrossRefGoogle Scholar
Cutler, D.M. (2002), ‘Equality, efficiency and market fundamentals: the dynamics of international medical-care reform’, Journal of Economic Literature, 40: 881906.CrossRefGoogle Scholar
Douven, R. and Schut, F.T.(2006), ‘Health plan pricing behaviour and managed competition’, Discussion Paper 61, CPB, The Hague.Google Scholar
Kifman, M. (2005), ‘Risk-selection and complementary health insurance: the Swiss approach’, Diskussionsbeitragäge Serie I – Nr. 328, Universität Konstanz.Google Scholar
Laske-Aldershof, T., Schut, F.T.Beck, K.Greß, S.Shmueli, A. and Van de Voorde, C.(2004), ‘Consumer mobility in social health insurance markets: a five-country comparison’, Applied Health Economics and Health Policy, 3(4): 229241.CrossRefGoogle Scholar
Laske-Aldershof, T. and Schut, F.T. (2005), ‘Monitor verzekerdenmobiliteit’, report for the Ministry of Health, Erasmus University Rotterdam.Google Scholar
Nuscheler, R. and Knaus, T. (2005), ‘Risk-selection in the German public health insurance system’, Health Economics 14(12): 12531271.CrossRefGoogle Scholar
NZa, i.o. (2006), ‘De tussenstand op de zorgverzekeringsmarkt’, Utrecht.Google Scholar
Paolucci, F., den Exter, A. and van de Ven, W.PM.M.(2006), ‘Solidarity in competitive health insurance markets: analysing the relevant EC legal framework’, Health Economics, Policy and Law, 1(2): 107126.CrossRefGoogle Scholar
Paolucci, F., Schut, F.T.and van de Ven, W.P.M.M.(2006), ‘Economic rationales for the design of health care financing schemes’, working paper 2006: 3. Scholar
Prinsze, F.J., van de Ven, Bruijn, D. and Schut, F.T.(2005), ‘Verbetering risicoverevening in de zorgverzekering’, report for the NPCF, Erasmus University Rotterdam.Google Scholar
Schokkaert, E. and Van de Voorde, C. (2003), ‘Belgium: risk adjustment and financial responsibility in a centralized system’, Health Policy, 65(1): 519.CrossRefGoogle Scholar
Schut, F.T. and Hassink, W.H.J. (2002), ‘Managed competition and consumer price sensitivity in social health insurance’, Journal of Health Economics, 802: 121.Google Scholar
Schut, F.T., Laske-Aldershof, T. and de Bruijn, D. (2004), ‘Effecten van de aanvullende ziekenfondsverzekering op de hoofdverzekering’, report for the Ministry of Health, Erasmus University Rotterdam.Google Scholar
Shmueli, A., Chernivkovsky, D. and Zmora, I.(2003), ‘Risk Adjustment and risk sharing: the Israeli experience’, Health Policy, 65(1): 3748.CrossRefGoogle Scholar
Tamm, M., Tauchmann, H.Wasem, J. and Greß, S. (2006), ‘Elasticities of market shares and social health insurance choice in Germany – a dynamic panel data approach’, Health Economics, forthcoming, DOI: 10.1002/hec.167.Google Scholar
Tegenbos, G. (2005) ‘Oorlog onder ziekenfondsen’ (War amongst sickness funds), De Standaard, 28 September.Google Scholar
Van de Ven, W.P.M.M., et al. . (2003), ‘Risk adjustment and risk-selection on the sickness fund insurance market in five European countries’, Health Policy, 65(1): 7598.CrossRefGoogle Scholar
Wasem, J., Greß, S. and Okma, K.G.H. (2004), ‘The role of private health insurance in social health insurance countries’, in Saltman, R.Busse, R. and Figueras, J.(eds), Social Health Insurance in Western Europe, London: Open University Press, pp. 227247.Google Scholar