Kifmann, Mathias
Insuring Premium Risk in Competitive Health Insurance Markets

How can it be avoided that consumers face premium risk, i.e. increases in their premiums when their health status deteriorates? This problem is a major challenge for private health insurance markets. Kifmann analyzes how premium risk can be insured in competitive health insurance markets. He pays particular attention to the challenges posed by managed care and shows possible strategies for reform. Three principal ways to insure premium risk which preserve competition among health insurers are analyzed and compared. Guaranteed renewable contracts ensure premiums independent of changes in the health status by requiring a life-time commitment to an insurer. Premium insurance compensates an increase in premiums if the health status changes. Under community rating, the government rules out risk-based premiums by requiring that insurers set a uniform premium for all insured. Mathias Kifmann pays particular attention to the challenges posed by managed care. He argues that managed care can aggravate the lock-in problem under guaranteed renewable contracts. He demonstrates that an alternative contract is superior to guaranteed renewable contracts. This contract creates incentives for insurers to behave in the interest of consumers by specifying payments upon switching to another insurer. If insurers are community-rated, an important question is whether they should be allowed to offer managed care besides traditional health insurance. The author shows that managed care can be used as a pure risk-selection device under community rating. However, the introduction of managed care can also be to the benefit of everyone. To obtain such welfare gains, it may be necessary to tax some insurance plans and to subsidize others. XI,155 Seiten mit 9 Abb. und 10 Tab., Leinen (Beiträge zur Finanzwissenschaft; Band 15/Mohr Siebeck 2002) leichte Lagerspuren/minor shelfwear