infonet-economy

In this paper we analyse the developments concerning risk adjustment and risk selection in Belgium, Germany, Israel, the Netherlands and Switzerland in the period 2000–2006. Since 2000 two major trends can be observed. On the one hand the risk adjustment systems have been improved, for example, by adding relevant health-based risk adjusters. On the other hand in all five countries there is evidence of increasing risk selection, which increasingly becomes a problem, in particular in Germany and Switzerland. Some potential explanations are given for these seemingly contradictory observations.

Since the mid-1990s citizens in these countries can regularly switch sickness fund, which should stimulate the sickness funds to improve efficiency in health care production and to respond to consumers’ preferences. When looking at managed care there are some weak signals of increasing managed care activities by individual sickness funds in all countries (except Belgium). However, with imperfect risk adjustment, such as in Israel and Switzerland, insurers will integrate their managed care activities with their selection activities, which may have adverse effects for society, even if all insurers are equally successful in selection.

The conclusion is that good risk adjustment is an essential pre-condition for reaping the benefits of a competitive health insurance market. Without good risk adjustment the disadvantages of a competitive insurance market may outweigh its advantages.

Theoretically, a risk avers consumer takes a deductible if the premium rebate (far) exceeds his/her expected out-of-pocket expenditures. In the absence of risk equalization, insurers are able to offer high rebates because those who select into a deductible plan have below-average expenses. This paper shows that, for high deductibles, such rebates cannot be offered if risk equalization would “perfectly” adjust for the effect of self selection. Since the main goal of user charges is to reduce moral hazard, some effect of self selection on the premium rebate can be justified to increase the viability of voluntary deductibles.

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

Für Managed-Care-Organisationen ist es entscheidend, dass die Kopfpauschale pro Versicherten (Capitation) risikogerecht
berechnet ist. Eine neue Formel bezieht erstmals auch identifizierte chronische Erkrankungen mit ein. Die Autoren bezeichnen dies als Durchbruch.

Bei Untersuchungen zu Kostenvorteilen von MC werden meist einzelne Massnahmen isoliert betrachtet. Um aussagestarke Ergebnisse zu erhalten, braucht es Untersuchungen, bei denen
die Gesamteffekte von Massnahmen den Gesamtkosten gegenübergestellt werden. Ein weiterer Aspekt mit Forschungsbedarf ist die Qualität: Verbesserte Qualitätsmessungen würden nicht nur MC zugute kommen, sondern
den Wettbewerb unter allen Leistungserbringern Richtung Qualitätswettbewerb lenken.

Die Abwägung von Kosten und Nutzen spielt bei der Bereitstellung öffentlicher Güter eine zentrale Rolle. Mithilfe welcher Methode lässt sich der Nutzen öffentlicher Güter am besten schätzen? Welche typischen konzeptionellen und empirischen Probleme treten bei den einzelnen Schätzmethoden häufig auf?

Die Abstufung der Krankenkassenprämien nach Rauchern und Nichtrauchern würde einen Schritt weg von der Einheitsprämie bedeuten. Die Autoren des folgenden Beitrags kommen in ihrer ökonomischen Analyse zum Schluss, dass diese Abstufung die Effizienz der gesetzlichen Krankenversicherung verbessern würde

Previous studies in positive psychology have indicated that work satisfaction is an important determinant of individual well-being. Research has suggested that people are most satisfied with their work when they are doing what they are drawn to naturally. We provide further evidence on this issue from a large representative data set, the German Socio-Economic Panel (SOEP). The 2005 wave of the SOEP contains a battery of personality questions as well as detailed information on personal life and work life. We extract the Big Five personality factors and one character strength: vitality. The main results are based on regression analysis. The analysis supports the hypothesis that certain personality clusters are more predominant in some occupations than in others. Furthermore, an alignment between personal profile and occupational profile tends to be related positively to satisfaction. These results indicate that ignoring mental aspects of work has its price in terms of well-being. They also highlight the importance of studying the way we structure work and harness personality and individual strengths within positive psychology.

Trust and betrayal of trust are ubiquitous in human societies. Recent behavioral evidence shows that the neuropeptide oxytocin increases trust among humans, thus offering a unique chance of gaining a deeper understanding of the neural mechanisms underlying trust and the adaptation to breach of trust. We examined the neural circuitry of trusting behavior by combining the intranasal, double-blind, administration of oxytocin with fMRI. We find that subjects in the oxytocin group show no change in their trusting behavior after they learned that their trust had been breached several times while subjects receiving placebo decrease their trust. This difference in trust adaptation is associated with a specific reduction in activation in the amygdala, the midbrain regions, and the dorsal striatum in subjects receiving oxytocin, suggesting that neural systems mediating fear processing (amygdala and midbrain regions) and behavioral adaptations to feedback information (dorsal striatum) modulate oxytocin’s effect on trust. These findings may help to develop deeper insights into mental disorders such as social phobia and autism, which are characterized by persistent fear or avoidance of social interactions.

Häufig wird die Globalisierung und auch die Welthandelsorganisation WTO für den verstärkten Raubbau an der Umwelt verantwortlich gemacht. Eine wichtige Rolle beim
Schutz der Umwelt spielen die Eigentumsrechte. Wie kann erreicht werden, dass der Eigentümer vom Schutz der Umwelt profitiert, die externen Kosten also internalisiert werden?