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Related Experiment Videos

Risk adjustment in Switzerland.

Konstantin Beck1, Stefan Spycher, Alberto Holly

  • 1Department of Statistics, PO Box 2568, CH-6002, Lucerne, Switzerland. konstantin.beck@css.ch

Health Policy (Amsterdam, Netherlands)
|June 24, 2003
PubMed
Summary

Switzerland's 1996 Health Insurance law aimed for competition but low consumer mobility persists. Imperfect risk adjustment based on demographics still allows profitable risk selection by sickness funds.

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Area of Science:

  • Health Economics
  • Insurance Market Regulation

Background:

  • Switzerland's 1996 Health Insurance law introduced pro-competitive changes.
  • The law aimed to increase consumer mobility between sickness funds via open enrollment.
  • A risk adjustment scheme, introduced in 1993, was limited until 2005.

Purpose of the Study:

  • To analyze the impact of imperfect risk adjustment on Switzerland's sickness fund market.
  • To examine consumer mobility and risk selection strategies.
  • To assess the influence on Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) models.

Main Methods:

  • Analysis of Swiss health insurance market dynamics.
  • Review of risk adjustment mechanisms and their limitations.
  • Examination of consumer behavior and insurer strategies.

Main Results:

  • Consumer mobility between sickness funds remained low despite legislative changes.
  • Risk selection strategies remain profitable due to demographic-based risk adjustment.
  • Imperfect risk adjustment influences the development of managed care models like HMOs and PPOs.

Conclusions:

  • The Swiss health insurance market exhibits persistent low consumer mobility.
  • Current risk adjustment methods are insufficient to curb profitable risk selection.
  • Ongoing political and scientific discussions address these market imperfections.

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