Free Choice of Sickness Funds in Social Health Insurance - Theoretical Foundation and Empirical Findings in Germany

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1 Stefan Greß, Jürgen Wasem (University of Greifswald) Erik Schut (University of Rotterdam) Free Choice of Sickness Funds in Social Health Insurance - Theoretical Foundation and Empirical Findings in Germany Presentation at the Fourth European Conference on Health Economics Paris, 7-10 July 2002 Contact: gress@uni-greifswald.de Seite 1

2 Outline Problem Social health insurance in Germany Research questions Method Data Results Discussion Seite 2

3 Problem Free choice of sickness funds plus risk adjustment introduced in 1996 Primary motivation Equal right to choose for all insured Decrease of contribution rate differences Secondary motivation Increased efficiency of the system Sickness funds to act as prudent buyers for their insured Crucial precondition for effective price competition: consumers shop around Seite 3

4 German Triangle of Regulated Competition Insured Consumer Choice Neither Higher Quality nor more Efficiency in Health Services Insurer No Selective Contracting Provider Seite 4

5 Social Health Insurcance in Germany Solidarity fund Employers Risk-adjusted compensation payments (RSA) Subscribers Income-related premium (50%) (set by sickness fund) Sickness funds Seite 5

6 Research Questions Do consumers indeed search for lower-priced sickness funds? How can the level of price sensitivity be explained? Seite 6

7 Method Estimation of price elasticity of sickness fund choice using panel data at the individual sickness fund/type of sickness fund level Period: /2001 Estimation method: fixed effects Dependent variable: Market share (number of subscribers) per (type of) sickness fund For all subscribers For subgroups of over/under 65 years of age Independent variables: Out-of pocket premium Dummy per (type of) sickness fund Dummy per year Seite 7

8 Data Sickness Funds Types of sickness funds Total number of subscribers (excl. dependents) Pensioners and non-pensioners Income-related contribution by type Provided by Ministry of Health Individual sickness funds Provided by branch organization All 17 AOK funds 20 substitute funds (West and East) 6 BKK funds and only 1 IKK fund (Internet) Complete data set Open enrolment Residual BKK and IKK fund Seite 8

9 Estimated Price Elasticity Seite 9

10 Summary of Results High and rapidly increasing price elasticities Price elasticities for Non-pensioners higher than for pensioners and for individual funds higher than for type of funds Further need for research Data for individual funds is incomplete Influence of limited choice in 2001 Change of Employer Increase of Contribution rate Influence of new regulation in 2002 Old regulation: Change once a year (September 30) New regulation: Change all year (After staying with the fund for at least 18 months) Seite 10

11 Explanation of Results High financial risk for sickness funds High differences in contribution rates 400 a year for average income employee 750 a year for high-income employee Search costs are low compared to potential gains High incentives for employers Same potential gain for employers Funds market their product at personnel offices Employers massivel influence choice Competitive market structure Large number of funds and new entrants Tradition of choice Seite 11

12 Discussion Different contribution rates mostly due to Uneven distribution of risks Imperfect risk adjustment Only small fraction explained by differences in administrative efficiency Bad risks switch less often Almost no selective contracting Welfare effects of freedom of choice unclear Improvement on status quo ante Funds engage in risk selection Seite 12

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