Effects of Selective Contracting with Positive Incentives on the Choices of Dutch Consumers for Health Care Options: Results of an Experiment

Abstract

Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incen-tivized to compete on price for basic health insurance, and on price and quality for supplementary insurance. It is possible for health insurers to implement a differentiated deductible since the first of January 2009. This paper describes an experiment. It is designed to study this differentiated deductible as a financial policy instrument. It focuses on the effect of selective contracting with positive incentives on the choice-behaviour of the insured. The goal of this study is to gain insight in the working mechanism of this financial policy instrument that is meant to reduce healthcare costs. The study is designed as a vignette study. The vignettes are presented in pairs of two to the respondents. The vignettes contain various elements including premium costs, deductible, degree of selective contracting and availability of quality-information (CQI). As the respondents in the design of this choice experiment have to choose between confronting health plans, it is understandable that they value these policies on their characteristics (so-called attributes). Subsequently, a statement can be formulated on the relative value assigned to these attributes by the respondents, clearly preferring one health plan over the other. Finally 99 respondents were included in our study. Logistic regression analysis was performed. This study shows that the deducti-ble as choice-influencing instrument has less influence as age increases. The proclaimed cost savings of this deductible might be lower than expected. Generally, it can be concluded that healthier people are less likely to choose the extensive health plan. However, this effect reverses when the most extensive and less extensive are presented to the participants. The results thus show a clear demarcation in the preferences of consumers. A similar demarcation also has been found in the data concerning travel distance. When contracted care is within 30 minutes, this health plan is preferred over the more extensive and expensive one. However, this study also shows that this effect reverses when the travel distance increases to 45 minutes. Consumers in this situation are reluctant to choose selective care and choose for the extensive and expensive option. Premium costs have a negative effect. A health plan becomes less attractive when the price increases. In addition, an increase in the availability of CQI makes a health plan more attractive. It can be concluded from this study that the deductible as choice-influencing instrument seems to work for young and healthy people, provided that they do not have to travel more that 30 minutes.