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July 24, 2020

Eigen betalingen in de Zorgverzekeringswet: bijlage bij het rapport 'Zorgkeuzes in Kaart 2020'

Publication (in Dutch only)

In 'Zorgkeuzes in Kaart 2020' is een nieuwe methodiek gebruikt om de budgettaire effecten van wijzigingen van de vormgeving van eigen betalingen in de Zorgverzekeringswet (Zvw) te kwantificeren. Voorbeelden van zulke wijzigingen zijn het afschaffen van het verplicht eigen risico in de Zvw of het vervangen van het verplicht eigen risico door een procentueel eigen risico. De basis van de nieuwe methodiek is een nieuw microsimulatiemodel dat is ontwikkeld door het Centraal Planbureau. In dit achtergronddocument wordt het simulatiemodel beschreven en wordt uitgelegd hoe het model is ingezet voor 'Zorgkeuzes in Kaart 2020'. Daarnaast worden de belangrijkste uitkomsten gepresenteerd.

July 24, 2020

A Structural Microsimulation Model for Demand-Side Cost-Sharing in Healthcare

Publication

Demand-side cost-sharing schemes reduce moral hazard in healthcare at the expense of out-of-pocket risk and equity. With a structural microsimulation model, we show that shifting the starting point of the deductible away from zero to 400 euros for all insured individuals, leads to an average 4 percent reduction in healthcare expenditure and 47 percent lower out-of-pocket payments. We use administrative healthcare expenditure data and focus on the price elastic part of the Dutch population to analyze the differences between the cost-sharing schemes. The model is estimated with a Bayesian mixture model to capture distributions of healthcare expenditure with which we predict the effects of cost-sharing schemes that are not present in our data.

March 15, 2019

Selection and moral hazard effects in healthcare

Publication

In the Netherlands, average healthcare expenditures of persons without a voluntary deductible are twice as high as average healthcare expenditures of persons with a voluntary deductible. When assessing the effects of voluntary cost-sharing in healthcare on healthcare expenditures, it is important to disentangle moral hazard from selection: are healthcare expenditures low because people pay (a bigger share of) their healthcare expenditures out-of-pocket? Or are people with higher cost-sharing levels healthier? In this study, we separate selection from moral hazard for the combined mandatory and voluntary deductible in the Netherlands. We use proprietary claims data from Dutch health insurers and exploit with a panel regression discontinuity design that we can observe healthcare expenditures before and after the deductibles kick in for 18 year olds.

December 7, 2017

Cost-Sharing Design Matters: A Comparison of the Rebate and Deductible in Healthcare

Publication

Since 2006, the Dutch population has faced two different cost-sharing schemes in health insurance for curative care: a mandatory rebate of 255 euros in 2006 and 2007, and since 2008 a mandatory deductible. Using administrative data for the entire Dutch population, we compare the effect of both cost-sharing schemes on healthcare consumption between 2006 and 2013.

April 25, 2014

Provider competition and over-utilization in health care

Publication

This paper compares the welfare effects of three ways in which health care can be organized.

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