Applied Health Economics and Health Policy

, Volume 3, Issue 4, pp 229–241 | Cite as

Consumer mobility in social health insurance markets

A five-country comparison
  • Trea Laske-AldershofEmail author
  • Erik Schut
  • Konstantin Beck
  • Stefan Greß
  • Amir Shmueli
  • Carine Van de Voorde


During the 1990s, the social health insurance schemes of Germany, the Netherlands, Switzerland, Belgium and Israel were significantly reformed by the introduction of freedom of choice (open enrolment) of health insurer. This was introduced alongside a system of risk adjustment to compensate health insurers for enrolees with predictable high medical expenses. Despite the similarity in the health insurance reforms in these countries, we find that both the rationale behind these reforms and their impact on consumer choice vary widely.

In this article we seek to explain the observed variation in switching rates by cross-country comparison of the potential determinants of health insurer choice. We conclude that differences in choice setting, and in the net benefits of switching, offer a plausible explanation for the large differences in consumer mobility.

Finally, we discuss the policy implications of our cross-country comparison. We argue that the optimal switching rate crucially depends on the goals of the reforms and the quality of the risk-adjustment system. In view of this, we conclude that switching rates are currently too low in the Netherlands, and an active government policy to encourage consumer mobility seems warranted. In Germany and Switzerland, high switching rates call for an improvement of the rather poor risk-adjustment systems. Given low switching rates in Israel and Belgium, improving risk adjustment is less urgent, but still required in the long run.


Switching Cost Choice Setting Health Insurer Sickness Fund Switching Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We like to thank two anonymous referees and all members of the Risk Adjustment Network for their useful comments on previous drafts. ## No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.


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Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Trea Laske-Aldershof
    • 1
    Email author
  • Erik Schut
    • 1
  • Konstantin Beck
    • 2
  • Stefan Greß
    • 3
  • Amir Shmueli
    • 4
  • Carine Van de Voorde
    • 5
  1. 1.Institute of Health Policy and ManagementErasmus University Medical CentreRotterdamThe Netherlands
  2. 2.Department of StatisticsCSS InsuranceLucerneSwitzerland
  3. 3.Institute for Health Care ManagementUniversity of Duisberg-EssenEssenGermany
  4. 4.Department of Health Management, School of Public HealthThe Hebrew UniversityJerusalemIsrael
  5. 5.Centre for Economic StudiesKatholieke Universiteit LeuvenLeuvenBelgium

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