Confronted with the continuing cost expansion in the health care
sector, policy makers face a dilemma: limiting moral hazard in
medical care requires that consumers participate in the cost, yet
copayment is strongly resisted by today's socially insured. Thus,
the experiences of three private German health insurers will be of
interest to physicians, social scientists, and policy makers.
Insurer A writes conventional plans with deductibles and
coinsurance; B pays back three-monthly premiums as a fixed rebate
for no claims; while C runs an experience-rated bonus system
starting with a rebate of three-monthly premiums for the first year
without a claim, reaching a maximum of five after three years.
While both rebates and bonuses are quite popular among insureds,
this study shows that bonus options are particularly effective in
limiting the demand for ambulatory and even hospital care. But what
about adverse effects on health caused by the desire to save one's
bonus? On this issue, there is some surprising evidence.
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