A voluntary deductible in social health insurance with risk equalization: "Community-rated or risk-rated premium rebate?"

On January 1, 2006 a new mandatory basic health insurance will be introduced in the Netherlands. One aspect of the new scheme is that the insured can choose to have a deductible. This option should increase the individual responsibility and reduce moral hazard. In the new scheme, a risk equalization system is aimed at avoiding preferred risk selection and insolvency of insurance companies with a relatively high-risk pool. A crucial issue with respect to a voluntary deductible in this type of social health insurance is whether the premium rebate should be community rated or risk rated. The Dutch government has chosen the former, which means that the premium rebate will be independent of health status and risk. Our analysis shows that, in a situation with "accurate" risk equalization, a community-rated premium rebate could lead to an adverse selection spiral. Over time, this spiral results in none of the insured taking a deductible and thus no reduction in moral hazard.

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