Thomson, Sarah Busse, Reinhard Crivelli, Luca Van de Vend Van de Voordee, Carine 2013 This article considers the potential for insurer competition to improve health system performance by strengthening purchasing. Economic theory suggests that insurer competition will enhance efficiency if: (1) people have free choice of insurer, (2) competition is based on price and quality rather than risk selection and (3) insurers have tools to influence health care costs and quality. The article assesses the extent to which these assumptions hold in Belgium, Germany, the Netherlands and Switzerland. It finds that health insurance market reforms in these countries have had mixed results in fulfilling these assumptions. In spite of significant investment in risk equalisation, incentives for risk selection remain. Consumer mobility is lower among older and chronically ill people, possibly due to close interaction between statutory and voluntary coverage. Although insurers in some countries increasingly have tools to enhance value, they may not always use them. The analysis suggests that the instrumental value of insurer competition rests on multiple assumptions that can only be upheld through frequently complex interventions often requiring elusive data. Making it work therefore requires action on several fronts, particularly to ensure incentives are aligned across the health system, and awareness of the political nature of some barriers to success. application/pdf https://susi.usi.ch/global/documents/318574 https://localhost:5000/ark:/12658/srd1318574 https://susi.usi.ch/documents/318574/files/crivelli_HP_2013.pdf eng info:eu-repo/semantics/altIdentifier/doi/10.1016/j.healthpol.2013.01.005 info:eu-repo/semantics/altIdentifier/ark/12658/srd1318574 info:eu-repo/semantics/openAccess License undefined Health policy. - Elsevier. - 2013, vol. 109, no. 3, p. 209-225 Health insurance choice competition Europe info:eu-repo/classification/udc/61 Statutory health insurance competition in Europe : a four-country comparison http://purl.org/coar/resource_type/c_6501