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many countries have introduced competitive health insurance mechanisms, while introducing regulation to avoid risk selection and ensure solidarity between the sick and the good. The 'regulated competition' model is thus applied to basic health insurance in Switzerland, the Netherlands, Germany and Israel. It inspires the reform of health insurance in the United States. In order to analyse the functioning of such a system, the case of Switzerland is considered, looking at potential interferences between the supplementary insurance market and competition in the basic insurance market. The current organisation of health insurance in France differs from that of the Swiss system. However, the question of regulating the supplementary insurance market could be raised in the long term. Twelve years after the introduction of regulated competition, the results in Switzerland are disappointing. While for the same contract the differences in premiums between insurance companies may be very large, the proportion of policyholders changing cash remains low. Everything happens as if insured persons did not compete. Our analysis shows that the low mobility of insured persons results from the co-existence of two health insurance markets with different rules: the market for basic insurance, where risk selection is prohibited, and for supplementary insurance, where it is authorised. Estimates show that the propensity to change funds is much lower among holders of additional insurance who feel that their health is not excellent. The right to select applicants for supplementary insurance undermines competition on the basic insurance. ; Many countries have introduced competition in health insurance markets. Managed competition settings have been implemented in order to avoid risk selection problems. In Germany, the Netherlands, Switzerland and Israel citizens can choose between different providers for basic coverage. In this article, we focus on the specific case of Switzerland which implemented managed competition in basic health ...

This paper focuses on the switching behaviour of sickness fund enrolees in the Swiss health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there still remains large premium variations within cantons. This indicates that competition has not been able so far to lead to a single price, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of the supplementary insurance. Our aim is to analyse two decisions (switching decision in basic insurance, subscription to supplementary insurance contracts). We use survey data on health plan choice and import some market data related to the sickness funds (number of enrollees, premiums). The decision to switch and the decision to subscribe to a supplementary contract are estimated both separately and jointly. The results suggest that holding a supplementary insurance contract substantially decreases the propensity to switch. However the impact of supplementary insurance is not significant when the individual assesses his/her health as "very good" ; to the contrary, holding a supplementary contract significantly reduces the propensity to switch when the indivual's subjective health status deteriorates. Futhermore, the switching decision is positively influenced by the expected gain of switching. In comparison with the range of the premium difference, the limitations to switch due to the supplementary insurance is moderate, though non negligible. As for the decision to subscribe a supplementary contract, the results show that the income level has a direct positive influence on the propensity to buy a supplementary insurance. Our results suggest that a major mechanism is going on in relation to supplementary insurance: holding a supplementary contract might stop individuals from switching when the individual thinks that she/he could be regarded as a bad risk due to the selection practices that are allowed in supplementary insurance markets. This result bears major policy implications concerning the regulation of basic and supplementary insurance markets. ; Cet article étudie le comportement de changement de caisse d'assurance maladie en Suisse. Malgré la loi de 1996 qui visait à promouvoir la concurrence entre caisses pour l'assurance maladie de base, de grandes différences de primes subsistent au sein de chaque canton. Ceci indique que la concurrence n'a pas conduit à un prix unique et montre une certaine inertie des consommateurs. Nous analysons une barrière potentielle au comportement de mobilité des consommateurs, à savoir l'impact de l'assurance complémentaire. L'analyse empirique porte sur des données d'enquête sur le choix d'assurance maladie. Les résultats suggèrent que détenir une assurance complémentaire diminue sensiblement la propention à changer de caisse, sauf lorsque l'état de santé est très bon. En outre, le gain potentiel à changer de caisse augmente la probabilité de changer. Le revenu est un élément déterminant du choix de souscrire une assurance complémentaire. Nos résultats indiquent qu'un mauvais état de santé peut entraîner un individu à hésiter à changer de caisse, ignorant s'il sera encore possible de souscrire une assurance complémentaire auprès du nouvel assureur. Dans tous les cas, la demande pour l'assurance de base et pour l'assurance complémentaire étant liées, la régulation de chacun de ces marchés ne peut être faite isolément de l'autre.

This paper focuses on the switching behaviour of sickness fund enrolees in the Swiss health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there still remains large premium variations within cantons. This indicates that competition has not been able so far to lead to a single price, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of the supplementary insurance. Our aim is to analyse two decisions (switching decision in basic insurance, subscription to supplementary insurance contracts). We use survey data on health plan choice and import some market data related to the sickness funds (number of enrollees, premiums). The decision to switch and the decision to subscribe to a supplementary contract are estimated both separately and jointly. The results suggest that holding a supplementary insurance contract substantially decreases the propensity to switch. However the impact of supplementary insurance is not significant when the individual assesses his/her health as "very good" ; to the contrary, holding a supplementary contract significantly reduces the propensity to switch when the indivual's subjective health status deteriorates. Futhermore, the switching decision is positively influenced by the expected gain of switching. In comparison with the range of the premium difference, the limitations to switch due to the supplementary insurance is moderate, though non negligible. As for the decision to subscribe a supplementary contract, the results show that the income level has a direct positive influence on the propensity to buy a supplementary insurance. Our results suggest that a major mechanism is going on in relation to supplementary insurance: holding a supplementary contract might stop individuals from switching when the individual thinks that she/he could be ...

This paper focuses on the switching behaviour of sickness fund enrolees in the Swiss health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there still remains large premium variations within cantons. This indicates that competition has not been able so far to lead to a single price, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of the supplementary insurance. Our aim is to analyse two decisions (switching decision in basic insurance, subscription to supplementary insurance contracts). We use survey data on health plan choice and import some market data related to the sickness funds (number of enrollees, premiums). The decision to switch and the decision to subscribe to a supplementary contract are estimated both separately and jointly. The results suggest that holding a supplementary insurance contract substantially decreases the propensity to switch. However the impact of supplementary insurance is not significant when the individual assesses his/her health as "very good" ; to the contrary, holding a supplementary contract significantly reduces the propensity to switch when the indivual's subjective health status deteriorates. Futhermore, the switching decision is positively influenced by the expected gain of switching. In comparison with the range of the premium difference, the limitations to switch due to the supplementary insurance is moderate, though non negligible. As for the decision to subscribe a supplementary contract, the results show that the income level has a direct positive influence on the propensity to buy a supplementary insurance. Our results suggest that a major mechanism is going on in relation to supplementary insurance: holding a supplementary contract might stop individuals from switching when the individual thinks that she/he could be regarded as a bad risk due to the selection practices that are allowed in supplementary insurance markets. This result bears major policy implications concerning the regulation of basic and supplementary insurance markets. ; Cet article étudie le comportement de changement de caisse d'assurance maladie en Suisse. Malgré la loi de 1996 qui visait à promouvoir la concurrence entre caisses pour l'assurance maladie de base, de grandes différences de primes subsistent au sein de chaque canton. Ceci indique que la concurrence n'a pas conduit à un prix unique et montre une certaine inertie des consommateurs. Nous analysons une barrière potentielle au comportement de mobilité des consommateurs, à savoir l'impact de l'assurance complémentaire. L'analyse empirique porte sur des données d'enquête sur le choix d'assurance maladie. Les résultats suggèrent que détenir une assurance complémentaire diminue sensiblement la propention à changer de caisse, sauf lorsque l'état de santé est très bon. En outre, le gain potentiel à changer de caisse augmente la probabilité de changer. Le revenu est un élément déterminant du choix de souscrire une assurance complémentaire. Nos résultats indiquent qu'un mauvais état de santé peut entraîner un individu à hésiter à changer de caisse, ignorant s'il sera encore possible de souscrire une assurance complémentaire auprès du nouvel assureur. Dans tous les cas, la demande pour l'assurance de base et pour l'assurance complémentaire étant liées, la régulation de chacun de ces marchés ne peut être faite isolément de l'autre.

This paper focuses on the switching behaviour of sickness fund enrolees in the Swiss health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there still remains large premium variations within cantons. This indicates that competition has not been able so far to lead to a single price, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of the supplementary insurance. Our aim is to analyse two decisions (switching decision in basic insurance, subscription to supplementary insurance contracts). We use survey data on health plan choice and import some market data related to the sickness funds (number of enrollees, premiums). The decision to switch and the decision to subscribe to a supplementary contract are estimated both separately and jointly. The results suggest that holding a supplementary insurance contract substantially decreases the propensity to switch. However the impact of supplementary insurance is not significant when the individual assesses his/her health as "very good" ; to the contrary, holding a supplementary contract significantly reduces the propensity to switch when the indivual's subjective health status deteriorates. Futhermore, the switching decision is positively influenced by the expected gain of switching. In comparison with the range of the premium difference, the limitations to switch due to the supplementary insurance is moderate, though non negligible. As for the decision to subscribe a supplementary contract, the results show that the income level has a direct positive influence on the propensity to buy a supplementary insurance. Our results suggest that a major mechanism is going on in relation to supplementary insurance: holding a supplementary contract might stop individuals from switching when the individual thinks that she/he could be ...