Regulated Competition in Health Insurance Markets on Two Sides of the Atlantic.

Many high-income countries implement their policy of universal health insurance by individual health insurance in combination with regulated competition among insurers. Supported by public intervention, regulated competition can, in principle, address market failures in health insurance and smooth o...

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Publicado en:Journal of Economic Perspectives Vol. 40; no. 2; pp. 43 - 69
Autores principales: Kauer, Lukas, McGuire, Thomas G., Schillo, Sonja, van Kleef, Richard C.
Formato: Artículo
Publicado: American Economic Association Spring2026
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Acceso en línea:Ver este registro en EBSCOhost
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      dt: Spring2026
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        atl: Regulated Competition in Health Insurance Markets on Two Sides of the Atlantic.
      aug:
        au:
          Kauer, Lukas
          McGuire, Thomas G.
          Schillo, Sonja
          van Kleef, Richard C.
        affil:
          Lukas Kauer is Senior Lecturer and Researcher at the Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland.
          Thomas G. McGuire is Professor Emeritus in the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. He is also a Research Associate, National Bureau of Economic Research, Cambridge, Massachusetts.
          Sonja Schillo is Senior Researcher at the Federal Office for Social Security, Bonn, Germany.
          Richard C. van Kleef is Associate Professor at the Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
      su:
        Switzerland
        Germany
        Atlantic Ocean
        Netherlands
        Economic competition
        Medical care costs
        Health insurance exchanges
        Market failure
        Risk sharing
        National health insurance
      sug:
        subj:
          Economic competition
          Medical care costs
          Switzerland
          Germany
          Atlantic Ocean
          Netherlands
          Health insurance exchanges
          Market failure
          Risk sharing
          National health insurance
      ab: Many high-income countries implement their policy of universal health insurance by individual health insurance in combination with regulated competition among insurers. Supported by public intervention, regulated competition can, in principle, address market failures in health insurance and smooth out some inequities in the financial consequences of ill health and in the ability to pay for health insurance. We compare the national systems in Germany, the Netherlands, and Switzerland to the US Marketplaces, all of which use versions of regulated competition. While they show many similarities (for example, open enrollment, community-rated premiums with subsidies, comprehensive benefit package, risk adjustment), we focus on three major differences and their implications for market functioning: (1) mandatory and universal versus voluntary and partial (applying to only one sector of health insurance); (2) greater or lesser profit orientation of insurers; and (3) reliance on markets or regulation to contain costs.
      pubtype: Academic Journal
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    language: English
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