Background:In a private health insurance market, the premium an insurer charges contains a fee to cover the administrative costs of supplying insurance.
Objectives:We study variation in administrative costs within the basic health insurance for a Swiss insurer and investigate whether a customer’s morbidity causes higher administrative costs. If this is the case, administrative costs might need to be included in the risk adjustment system.
Methods:We use a difference-in-differences method to show the causal relationship between the onset of a chronic illness and the number of administrative customer contacts (phone, visits, email etc.) with the insurer.
Results:We find a positive and concave relationship between a customer’s health care expenditures and her administrative contacts, with a local expenditure elasticity around the average of 0.27.
Discussion:Using a back-of-the-envelope analysis we measure the costs of an administrative contact and find that administrative cost differences related to differences in the morbidity composition of an insurer’s population are small. For example, the difference in total administrative costs between two insurers, one with a very ill and the other with a very healthy population is about 5 CHF per customer.
Lukas Kauer, CSS Institute of Empirical Health Economics
Objectives:Health insurance in Switzerland is organized according to principles of regulated competition. To maintain risk solidarity, basic health insurance is mandatory and premiums are community-rated, potentially placing a high financial burden on low-income households. Therefore, means-tested premium subsidies are awarded to maintain affordability. We analyze different premium subsidy payout systems in order to assess their effect on the financial situation of transfer recipients.
Methods:Before 2014, some cantons paid the premium subsidy in-kind while other cantons applied a cash transfer. A reform led to a federally mandated harmonization of the transfer payout across all cantons, that is, all cantons must pay the premium subsidy in-kind since 2014. We can exploit this setting and apply a difference-in-differences approach on individual level data.
Results:We find that switching from cash to in-kind leads to an approximately 23% reduction in the probability that subsidized households miss paying their health insurance premiums on time and an approximately 19% reduction in the default probability. These effects seem partly driven by a consumption smoothing effect, which occurred in two cantons after the harmonization.
Discussion:From a policy perspective, the subsidy should enable the recipients to afford their health plan premium without creating adverse incentives. We provide evidence that steady in-kind transfers improve the financial situation of recipients most effectively.
Christian Schmid, CSS Institute for Empirical Health Economics
Many LMICs aim to scale up the coverage of health insurance schemes to ensure UHC. However, the percentage of the population enrolled in insurances is still low. To understand the fiscal effect of mandatory health insurance, we have to understand who uses how often what type of health services and where?
In this study, we analyze a large sample of 2,342,256 beneficiaries and 26,299,391 claims from mandatory insured public servants of the Tanzanian NHIF. Logistic regression was used to examine factors predictive of whether a beneficiary had a claim, while Tobit-model was used to study the number of claims per beneficiary and costs per claim.
The public servant beneficiaries represent about 4-5% of the total population. On average, 47.3% of the beneficiaries had at least one claim per year. 10% of the beneficiaries account for over 80% of the costs. In total, females, individuals between 30-49 years, and middle-income groups generate considerably higher costs to the NHIF, where the majority of the money flows into non-primary care and privately owned health facilities. An extrapolation of the cost structure to the entire population shows that the scheme requires a rethinking of the defined essential service packages or the funding sources in order to achieve UHC.
We provide insights into the functioning of a national health insurance in a low-income setting using claims data contributing to an improved understanding of the challenges of scaling up an insurance nationwide.
Kathrin Durizzo, ETH Zurich
Objectives: We study the impact of Organised Screening Programmes (OSP) for Breast Cancer in Europe on mammography uptake, inequality, and mortality. When an OSP is in place, all women within a certain age group receive, every two years, an invitation for free breast screening.
Methods: To identify the causal impact of this invitation, we exploit the heterogeneity across European regions in the availability of OSP and in the age eligibility across regions with OSP. Our analysis is based on three data sources: (1) regional information on OSP, (2) individual information on mammography uptake, socioeconomic characteristics, health, and lifestyle related risk factors of women in 21 European countries, and (3) cancer registry data on breast cancer incidence, and mortality.
Results: We find new evidence that screening increases by more than 30 percentage points when women are invited. First results from the heterogeneity analysis show that women that respond to the invitation are those at higher risk of developing cancer and those with low preventive healthcare habits.
Discussion: OSP with a personal invitation manage to reach asymptomatic women at higher risk of developing cancer and with low preventive healthcare habits, i.e. women that are less likely to go for a mammography otherwise. Further analyses will investigate the impact of OSP on socioeconomic inequalities, breast cancer incidence, and mortality.
Sophie Guthmuller, Vienna University of Economics and Business
Background:With healthcare expenses approaching 13% of the gross domestic product (GDP), the financial sustainability of the Swiss healthcare system has become a matter of concern. Several cost containment strategies are currently discussed, including the limitation of access to certain services. A less harmful strategy is to cut waste, i.e. inefficiencies, in how health care is provided.
Objectives: We estimate the savings potential from reducing inefficiencies in the provision of health care services that are financed by the compulsory health insurance (CHI) in Switzerland.
Methods: We defined a comprehensive waste framework with eight distinct inefficiency domains, four corresponding to allocative and four to productive inefficiencies. Applying a variety of different estimation strategies per domain, we then estimated the efficiency potential for 14 health services.
Results: We find an overall efficiency potential of 7.1-8.4 bn CHF, or 16%-19% of health care spending for CHI services. Due to significant gaps and limitations in available data, this corresponds to a lower bound of the true potential. The health services with the largest relative inefficiencies are outpatient radiology (18%-48%), inpatient psychiatric care (25%-26%), outpatient acute care (21%-23%) and outpatient laboratory services (18%-22%).
Discussion: Knowing the amount of inefficiency and its causes allows policy makers to design tailored health care reforms that will generate incentives for better efficiency and reduce wasteful spending
Simon Wieser, Zurich University of Applied Sciences