In 1995 dental services were excluded from the compulsory health insurance package that covers the families of all Dutch employees in the market sector with incomes below a certain threshold. People had to choose between no insurance and supplementary insurance. The exclusion of dental services was unexpected and was accompanied by a generous acceptance policy and almost uniform premiums. Due to these features the exclusion constitutes a natural experiment to investigate whether customers with poorer teeth conditions are more likely to buy insurance. This is a key condition for adverse selection to matter. The empirical results show that adverse selection indeed occurs; individuals with poor teeth condition are more likely to choose insurance. The same holds for customers with more frequent visits in the past. Differences in prices play some role, whereas differences in income do not.
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- Cameron, A.C. and P.K. Trivedi (1991), ‘The Role of Income and Health Risk in the Choice of Health Insurance; Evidence from Australia,’ Journal of Public Economics, 45, pp. 1–28.Google Scholar
- Cramer, J.S. (1991), The LOGIT Model: An Introduction for Economists, London, Edward Arnold.Google Scholar
- Geurts, J.J.M. and F.F.H. Rutten (1987), ‘Tot de tanden verzekerd; de verzekeringskeuze voor tandheelkundige hulp nader onderzocht,’ Nederlands Tijdschrift Tandheelkunde, 94, pp. 287–291.Google Scholar
- Kalsbeek, H., G.J. Truin, G.M.J.M. van Rossum, H.M. van Rijkom, J.H.G. Poorterman and G.H. Verrips (1998), ‘Trends in Caries Prevalence in Dutch Adults between 1983 and 1995,’ Caries Research, 32, pp. 160–165.Google Scholar
- Marquis, M.S. (1992), ‘Adverse Selection with a Multiple Choice among Health Insurance Plans: A Simulation Analysis,’ Journal of Health Economics, 11, pp. 129–151.Google Scholar
- Marquis, M.S. and C.E. Phelps (1987), ‘Price Elasticity and Adverse Selection in the Demand for Supplementary Health Insurance,’ Economic Inquiry, 25, pp. 299–313.Google Scholar
- Neipp, J. and R.J. Zeckhauser (1985), ‘Persistence in the Choice of Health Plans,’ in: R.M. Schleffler and L.F. Rossiter (eds.), Advances in Health Economics and Health Services Research, Volume 6. Biased Selection in Health Care Markets, Greenwich, CT, JAI Press.Google Scholar
- Newhouse, J.P. (1996), ‘Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection,’ Journal of Economic Literature, 34, pp. 1236–1263.Google Scholar
- Rothschild, M. and J. Stiglitz (1976), ‘Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information,’ Quarterly Journal of Economics, 90, pp. 629–649.Google Scholar
- Salanié, B. (1997), The Economics of Contracts, Cambridge/London, MIT Press.Google Scholar
- Swinkels, H. and J. Maessen (1996), ‘Het gebruik van tandheelkundige voorzieningen naar sociaaleconomische status tussen 1981 en 1995,’ Maandbericht Gezondheid, CBS 96/4.Google Scholar
- Wolfe, J.R. and J.H. Goddeeris (1991), ‘Adverse Selection, Moral Hazard, and Wealth Effects in the Medigap Insurance Market,’ Journal of Health Economics, 10, pp. 433–459.Google Scholar
- Ziekenfondsraad (1995), Evaluatie Beperking Aanspraken Tandheelkunde, No. 671.Google Scholar