Journal article

Statutory health insurance competition in Europe : a four-country comparison

  • Thomson, Sarah LSE Health and European Observatory on Health Systems and Policies, London, United Kingdom
  • Busse, Reinhard Berlin University of Technology, Dept. Health Care Management, Berlin, Germany
  • Crivelli, Luca Istituto di economia politica (IdEP), Facoltà di scienze economiche, Università della Svizzera italiana, Svizzera
  • Van de Vend Wynand
  • Van de Voordee, Carine Catholic University Leuven, Netherlands
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  • Health policy. - Elsevier. - 2013, vol. 109, no. 3, p. 209-225
English 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.
  • English
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