This article analyzes selection incentives for insurers in the Dutch basic health insurance market, which operates with community-rated premiums and sophisticated risk adjustment. Selection incentives result from the interplay of three market characteristics: possible actions by insurers, consumer response to these actions, and predictable variation in profitability of insurance contracts. After a qualitative analysis of the first two characteristics our primary objective is to identify the third. Using a combination of claims data (N = 16.8 million) and survey information (N = 387,195), we find substantial predictable variation in profitability. On average, people in good health are profitable, while those in poor health are unprofitable. We conclude that Dutch insurers indeed face selection incentives. A complete measure of selection incentives, however, captures the correlation between individual-level profitability and consumer response to insurer-actions. Obtaining insight in this correlation is an important direction for further research.

health insurance, risk selection, risk equalization, risk adjustment,
Medical Care Research and Review
Health Systems and Insurance

van Kleef, R.C, Eijkenaar, F, & van Vliet, R.C.J.A. (2019). Selection Incentives for Health Insurers in the Presence of Sophisticated Risk Adjustment. Medical Care Research and Review. doi:10.1177/1077558719825982