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Competitive health markets and risk equalisation in Australia: Lessons learnt from other countries
Journal article   Peer reviewed

Competitive health markets and risk equalisation in Australia: Lessons learnt from other countries

A. Fouda, G. Fiorentini and F. Paolucci
Applied Health Economics and Health Policy, Vol.15(6), pp.745-754
24/04/2017
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Abstract

The aims of this paper are to evaluate the risk equalisation (RE) arrangement in Australia’s private health insurance against practices in other countries with similar arrangements and to propose ways of improving the system to advance economic efficiency and solidarity. Possible regulatory responses to insurance market failures are reviewed based on standard economic arguments. We describe various regulatory strategies used elsewhere to identify essential system features against which the Australian system is compared. Our results reveal that RE is preferred over alternative regulatory strategies such as premium rate restrictions, premium compensation and claims equalisation. Compared with some countries’ practices, the calculated risk factors in Australia should be enhanced with further demographic, social and economic factors and indicators of long-term health issues. Other coveted features include prospective calculation and annual clearing of equalisation payments. Australia currently operates with a crude mechanism for RE in which the scheme incentivises insurers to select on risk rather than focusing on efficiency and equity-promoting actions. System changes should be introduced in a stepwise manner; thus, we propose an incremental reform.

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
International collaboration
Citation topics
1 Clinical & Life Sciences
1.14 Nursing
1.14.364 Healthcare Policy
Web Of Science research areas
Economics
Health Care Sciences & Services
Health Policy & Services
ESI research areas
Social Sciences, general
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