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Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets



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.


Corresponding author

*Corresponding author: Francesco Paolucci, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Tel: +31 10 408 8535; E-mail:


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Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets



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