R.C.J.A. van Vliet
Erasmus University Rotterdam
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Featured researches published by R.C.J.A. van Vliet.
Journal of Health Economics | 2008
R.C. van Kleef; Konstantin Beck; W.P.M.M. van de Ven; R.C.J.A. van Vliet
The presence of voluntary deductibles in the Swiss and Dutch mandatory health insurance has important implications for the respective risk equalization systems. In a theoretical analysis, we discuss the consequences of equalizing three types of expenditures: the net claims that are reimbursed by the insurer, the out-of-pocket expenditures and the expenditure savings due to moral hazard reduction. Equalizing only the net claims, as done in Switzerland, creates incentives for cream skimming and prevents insurers from incorporating out-of-pocket expenditures and moral hazard reductions into their premium structure. In an empirical analysis, we examine the effect of self-selection and conclude that the Swiss and Dutch risk equalization systems do not fully adjust for differences in health status between those who choose a deductible and those who do not. We discuss how this may lead to incentives for cream skimming and to a reduction of cross-subsidies from healthy to unhealthy individuals compared to a situation without voluntary deductibles.
Social Science & Medicine | 1989
E.K.A. van Doorslaer; R.C.J.A. van Vliet
This article provides an empirical re-examination of the relationship between regional hospital bed supply and the utilization of hospital care. It tests the hypothesis that the divergence of findings between studies based on micro-data (at the individual level) and those based on macro-data (at the regional level) is due to aggregation and specification bias. The main conclusion is that neither source of bias can account for the observed differences. Some other possible explanations are put forward. Regardless of the level of aggregation, a positive effect is found of bed supply on length of hospital stay but not on admission rates. This may be the result of major changes which have taken place in the financing of hospital services in the Netherlands during the last decade.
Journal of Health Economics | 2009
R.C. van Kleef; W.P.M.M. van de Ven; R.C.J.A. van Vliet
In health insurance, a traditional deductible (i.e. with a deductible range [0,d]) is in theory not effective in reducing moral hazard for individuals who know (ex-ante) that their expenditures will exceed the deductible amount d, e.g. those with a chronic disease. To increase the effectiveness, this paper proposes to shift the deductible range to [s(i),s(i)+d], with starting point s(i) depending on relevant risk characteristics of individual i. In an empirical illustration we assume the optimal shift to be such that the variance in out-of-pocket expenditures is maximized. Results indicate that for the 10-percent highest risks in our data the optimal starting point of a euro1000-deductible is to be found (far) beyond euro1200, which corresponds with a deductible range of [1200,2200] or further. We conclude that, compared to traditional deductibles, shifted deductibles with a risk-adjusted starting point lower out-of-pocket expenditures and may further reduce moral hazard.
Medical Care Research and Review | 2015
S. Van Veen; R.C. van Kleef; W.P.M.M. van de Ven; R.C.J.A. van Vliet
This study provides a taxonomy of measures-of-fit that have been used for evaluating risk-equalization models since 2000 and discusses important properties of these measures, including variations in analytic method. It is important to consider the properties of measures-of-fit and variations in analytic method, because they influence the outcomes of evaluations that eventually serve as a basis for policymaking. Analysis of 81 eligible studies resulted in the identification of 71 unique measures that were divided into 3 categories based on treatment of the prediction error: measured based on squared errors, untransformed errors, and absolute errors. We conclude that no single measure-of-fit is best across situations. The choice of a measure depends on preferences about the treatment of the prediction error and the analytic method. If the objective is measuring financial incentives for risk selection, the only adequate evaluation method is to assess the predictive performance for non-random groups.This study provides a taxonomy of measures-of-fit that have been used for evaluating risk-equalization models since 2000 and discusses important properties of these measures, including variations in analytic method. It is important to consider the properties of measures-of-fit and variations in analytic method, because they influence the outcomes of evaluations that eventually serve as a basis for policymaking. Analysis of 81 eligible studies resulted in the identification of 71 unique measures that were divided into 3 categories based on treatment of the prediction error: measured based on squared errors, untransformed errors, and absolute errors. We conclude that no single measure-of-fit is best across situations. The choice of a measure depends on preferences about the treatment of the prediction error and the analytic method. If the objective is measuring financial incentives for risk selection, the only adequate evaluation method is to assess the predictive performance for non-random groups.
Health Policy | 2014
R.C. van Kleef; R.C.J.A. van Vliet; E.M. van Rooijen
BACKGROUND The Dutch basic health-insurance scheme for curative care includes a risk equalization model (RE-model) to compensate competing health insurers for the predictable high costs of people in poor health. Since 2004, this RE-model includes the so-called Diagnoses-based Cost Groups (DCGs) as a risk adjuster. Until 2013, these DCGs have been mainly based on diagnoses from inpatient hospital treatment. OBJECTIVES This paper examines (1) to what extent the Dutch RE-model can be improved by extending the inpatient DCGs with diagnoses from outpatient hospital treatment and (2) how to treat outpatient diagnoses relative to their corresponding inpatient diagnoses. METHOD Based on individual-level administrative costs we estimate the Dutch RE-model with three different DCG modalities. Using individual-level survey information from a prior year we examine the outcomes of these modalities for different groups of people in poor health. CONCLUSIONS We find that extending DCGs with outpatient diagnoses has hardly any effect on the R-squared of the RE-model, but reduces the undercompensation for people with a chronic condition by about 8%. With respect to incentives, it may be preferable to make no distinction between corresponding inpatient and outpatient diagnoses in the DCG-classification, although this will be at the expense of the predictive accuracy of the RE-model.
International Journal of Health Care Finance & Economics | 2007
R.C. van Kleef; Konstantin Beck; Hf W. P. M. M. van de Ven; R.C.J.A. van Vliet
Theoretically, a risk avers consumer takes a deductible if the premium rebate (far) exceeds his/her expected out-of-pocket expenditures. In the absence of risk equalization, insurers are able to offer high rebates because those who select into a deductible plan have below-average expenses. This paper shows that, for high deductibles, such rebates cannot be offered if risk equalization would “perfectly” adjust for the effect of self selection. Since the main goal of user charges is to reduce moral hazard, some effect of self selection on the premium rebate can be justified to increase the viability of voluntary deductibles.
Health Policy | 1995
F.M. Bakker; R.C.J.A. van Vliet
We consider a situation of full insurance coverage for prescription drugs where, at a certain point in time, people are given the opportunity to take a deductible in exchange for a lower premium. Four determinants of this premium reduction can be considered: expected out-of-pocket payments, adverse selection effects, moral hazard effects, and administration costs. The purpose of this study is to analyse the first two determinants. Survey data of 17,242 insureds in the Netherlands have been used for this research. Results show that the expected out-of-pocket expenditures in case of a certain deductible amount depend strongly on age and gender. People in poor health could be given a larger premium discount if they would take a deductible than those in good health. This implies that a uniform premium discount would induce adverse selection. The effects of such selection have been simulated by using a survey question about the preference to take a general deductible. If the premium reductions for policies with a deductible are adjusted for age and gender, the selection effect will halve but will still be substantial. We conclude that, in the situation considered here, it is largely immaterial whether deductibles are compulsory or voluntary, provided premium reductions are allowed to depend on relevant risk factors.
European Journal of Health Economics | 2017
D. Cattel; R.C. van Kleef; R.C.J.A. van Vliet
Many health insurance schemes include deductibles to provide consumers with cost containment incentives (CCI) and to counteract moral hazard. Policymakers are faced with choices on the implementation of a specific cost sharing design. One of the guiding principles in this decision process could be which design leads to the strongest CCI. Despite the vast amount of literature on the effects of cost sharing, the relative effects of specific cost sharing designs—e.g., a traditional deductible versus a doughnut hole—will mostly be absent for a certain context. This papers aims at developing a simulation model to approximate the relative effects of different deductible modalities on the CCI. We argue that the CCI depends on the probability that healthcare expenses end up in the deductible range and the expected healthcare expenses given that they end up in the deductible range. Our empirical application shows that different deductible modalities result in different CCIs and that the CCI under a certain modality differs across risk-groups.
Tijdschrift voor gezondheidswetenschappen | 2015
W.P.M.M. van de Ven; R.C. van Kleef; R.C.J.A. van Vliet
Verzekerden kunnen elk jaar overstappen naar een andere zorgverzekering. Zorgverzekeraars moeten iedereen accepteren voor dezelfde premie per polis. De risicoverevening compenseert zorgverzekeraars vooraf voor voorspelbare, gezondheidgerelateerde kostenverschillen tussen verzekerden. Omdat deze verevening nog niet perfect is, bestaat ruimte voor risicoselectie door verzekerden en verzekeraars. Risicoselectie kan schadelijk zijn voor de publieke belangen kwaliteit, toegankelijkheid en betaalbaarheid van de zorg. Dit maakt risicoselectie een belangrijk aandachtspunt voor de Nederlandse Zorgautoriteit (NZa) die goedwerkende zorgmarkten maakt en bewaakt, en toezicht houdt op de publieke belangen. Tegen deze achtergrond staat de volgende vraag in dit artikel centraal: “Hoe kan de NZa risicoselectie op de zorgverzekeringsmarkt aantonen en meten?” Het precies meten en aantonen van (alle vormen van) risicoselectie blijkt niet eenvoudig. Dit artikel doet aanbevelingen voor een statistische en kwalitatieve benadering van dit meetprobleem. Naast empirische meetmethoden wordt een groot aantal (sterke) signalen genoemd die de NZa kan meten en die elk, en zeker in samenhang, duiden op risicoselectie. Dit biedt de NZa gereedschap om invulling te geven aan haar toezicht- en reguleringstaken betreffende risicoselectie. Het verdient aanbeveling na te gaan of de NZa over voldoende handhavingsinstrumenten beschikt om op te treden tegen ongewenste risicoselectie. Zo nodig moet de wetgever het wettelijke instrumentarium van de NZa uitbreiden.
Health Economics | 1993
R.C.J.A. van Vliet; W.P.M.M. van de Ven