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Selection Incentives in the Dutch Basic Health Insurance: To What Extent Does End-of-Life Spending Contribute to

A A Withagen-Koster1, R C van Kleef1, F Eijkenaar1

  • 1Erasmus University Rotterdam, The Netherlands.

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Summary

End-of-life spending significantly impacts insurer profits and losses, even with advanced risk equalization. This study reveals how spending in the final years of life affects financial predictability for specific patient groups.

Keywords:
end-of-life spendinghealth insurancerisk equalizationrisk selectionsurvey data

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Area of Science:

  • Health Economics
  • Health Services Research
  • Insurance Markets

Background:

  • Current risk-equalization models in individual health insurance do not fully account for predictable insurer profits/losses.
  • This leads to risk selection incentives for insurers.
  • Understanding drivers of remaining predictable profits/losses is crucial for model improvement.

Purpose of the Study:

  • To investigate end-of-life spending as a driver of predictable profits/losses.
  • To quantify the contribution of end-of-life spending to financial predictability in health insurance.
  • To inform improvements in risk-equalization models.

Main Methods:

  • Utilized large-scale administrative and health survey data from the Netherlands (N = 16.9m and N = 384k).
  • Simulated predictable profits/losses with and without end-of-life spending.
  • Corrected for overall spending differences between scenarios.

Main Results:

  • End-of-life spending contributes to predictable profits/losses for specific patient groups.
  • This contribution persists even with sophisticated risk-equalization models.
  • Chronic conditions were identified as particularly affected.

Conclusions:

  • End-of-life spending is a significant factor in the financial predictability of health insurance markets.
  • Existing risk-equalization models may need further refinement to account for end-of-life costs.
  • Further research into specific conditions is warranted to improve risk adjustment accuracy.