1;Preface;8 2;Contents;10 3;Chapter 1: General Introduction;14 3.1;1.1 Introduction;14 3.1.1;1.1.1 Many Definitions of Health Care Financing Schemes;15 3.1.2;1.1.2 Classifying Health Care Financing Schemes;16 3.1.3;1.1.3 Trends;19 3.1.4;1.1.4 Implications for Efficiency and Affordability;20 3.2;1.2 Aim and Contribution of This Study;22 3.3;1.3 Research Questions;23 4;Chapter 2: Economic Rationales for the Design of Health Care Financing Schemes;25 4.1;2.1 Introduction;25 4.2;2.2 Mandatory Cross-Subsidies;26 4.2.1;2.2.1 Externalities;26 4.2.1.1;2.2.1.1 Altruistic Preferences;27 4.2.1.1.1;Cost-Effectiveness of Services;28 4.2.1.1.2;Initial Health Status of the Beneficiary;29 4.2.1.1.3;The Expected Cost of Services per Consumer;31 4.2.1.1.4;Consumer´s Responsibility for the Incidence of the Disease;32 4.2.1.2;2.2.1.2 Egoistic Preferences;32 4.2.2;2.2.2 The Financial Risk of Becoming a High Risk;34 4.2.3;2.2.3 Moral Hazard;35 4.2.4;2.2.4 Summary;36 4.3;2.3 Mandatory Coverage;37 4.3.1;2.3.1 Economic Rationales for Mandatory Coverage;37 4.3.1.1;2.3.1.1 Free Riding;37 4.3.1.2;2.3.1.2 Lack of Foresight;38 4.3.1.3;2.3.1.3 Transaction Costs of Organising a System of Cross-Subsidies;40 4.3.1.4;2.3.1.4 Summary;40 4.3.2;2.3.2 Fine-Tuning Mandatory Coverage;41 4.3.2.1;2.3.2.1 High and Low Option Schemes;42 4.3.2.2;2.3.2.2 Single-Option Scheme with Income-Related Deductibles;43 4.4;2.4 Summary and Conclusions;43 5;Chapter 3: The Design of Health Care Financing Schemes in Different Countries;45 5.1;3.1 Introduction;45 5.2;3.2 Mandatory Cross-Subsidies in Different Countries;46 5.3;3.3 Mandatory Coverage in Different Countries;52 5.4;3.4 Conclusions;57 6;Chapter 4: The Potential for Risk Rating in Competitive Markets for Supplementary Health Insurance: An Empirical Analysis;59 6.1;4.1 Introduction;59 6.2;4.2 The Solidarity and Equivalence Principles;60 6.3;4.3 The Determinants of the Level of Risk Rating;61 6.3.1;4.3.1 Level of Competition;61 6.3.2;4.3.2 Consumers´ Willingness to Switch;62 6.3.3;4.3.3 Regulatory Framework;62 6.3.4;4.3.4 Transaction Costs;63 6.3.5;4.3.5 Self-Regulation;63 6.3.6;4.3.6 Choice of Risk Adjusters;64 6.4;4.4 Methods;65 6.5;4.5 Data;67 6.6;4.6 Results;68 6.6.1;4.6.1 The Potential Gains of Risk Rating in Competitive Supplementary Health Insurance Markets;68 6.6.2;4.6.2 Will Insurers Risk-Rate in Practice?;72 6.7;4.7 Conclusions;74 7;Chapter 5: Competition and Solidarity in European Markets for Basic and Supplementary Health Insurance: Economic and Legal Analysis;76 7.1;5.1 Introduction;76 7.2;5.2 Combining Competition and Solidarity in Health Insurance Markets;77 7.2.1;5.2.1 Premium Rate Restrictions;77 7.2.2;5.2.2 Risk-Compensation Schemes;78 7.2.3;5.2.3 Premium- and Excess-Loss-Compensation Schemes;81 7.3;5.3 Analysis of the EC Legal Framework;81 7.3.1;5.3.1 Free Movement of Services: The Insurance Directives;81 7.3.2;5.3.2 Competition Law;83 7.4;5.4 Are the Four Regulatory Strategies in Conformity with the EC Legal Framework?;85 7.5;5.5 Conclusions and Discussion;87 8;Chapter 6: Risk-Selection via Supplementary Health Insurance in Universal Mandatory Health Insurance for Basic Services;89 8.1;6.1 Introduction;89 8.2;6.2 Conceptual Framework;89 8.3;6.3 Risk-Selection via Supplementary Health Insurance;91 8.3.1;6.3.1 SI Markets in Different Countries: Main Features;91 8.3.2;6.3.2 The Determinants for the Use of SI as a Selection Device;94 8.3.3;6.3.3 BI Markets in Different Countries: Incentives for Risk-Selection;97 8.3.4;6.3.4 Evidence of Risk-Selection via SI;98 8.4;6.4 Conclusions and Discussion;100 9;Chapter 7: Conclusions and Discussion;102 9.1;7.1 Introduction;102 9.2;7.2 The Design of Basic and Supplementary Health Care Financing Schemes;103 9.3;7.3 Implications for Efficiency and Affordability;106 9.4;7.4 Epilogue;110 10;References;112 11;About the Author;124