Skip to main content

An Increasing Homogenisation of Private Health Insurers Under Solvency II?

  • 117 Accesses

Abstract

This chapter takes a European perspective to explores the main consequences of EU legislation on the strategic behaviour of private health insurers. Using quantitative data, it shows how changes led by the EU legislation in the insurers’ environment, in particular the public disengagement from health coverage, are creating a favourable environment for the emergence or development of more or less profitable national markets for private health insurance. Thus, the analysis of mergers and acquisitions (M&A) carried out in the private health insurance sector during the 2000s and 2010s and of their determinants shows how non-profit entities dominating the field in several EU countries tend to mimic for-profit insurers in terms of strategies and behaviours—with potential consequences for the provision of health benefits.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-54355-6_5
  • Chapter length: 31 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   109.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-54355-6
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   139.99
Price excludes VAT (USA)
Hardcover Book
USD   139.99
Price excludes VAT (USA)
Fig. 5.1
Fig. 5.2
Fig. 5.3
Fig. 5.4
Fig. 5.5
Fig. 5.6
Fig. 5.7
Fig. 5.8

Notes

  1. 1.

    This corresponds to the expenses that patients have to pay when no public or private health insurance system covers the total cost. It includes the share of expenditures paid by households to caregivers, including informal payments.

  2. 2.

    However, these expenditures fell slightly in some countries, particularly in the Czech Republic (−1.3%) and Slovenia (−1.1%).

  3. 3.

    Except Luxembourg, for which the data cannot be used.

  4. 4.

    Behavioural analysis is not studied in this work. It is assumed that the European countries selected are economically close enough to each other not to consider significant differences in the behaviour of the insurers on the health insurance markets, ceteris paribus.

  5. 5.

    The diversity of health systems does not allow this indicator to be constructed on the basis of a distinction between private and public insurance. This makes no sense, for example, when private insurers participate in compulsory health coverage (the Netherlands and Germany). To overcome this difficulty, only voluntary private insurance is taken into account here.

  6. 6.

    The Mergr database (Mergr.com) has been partially used as a complement or confirmation of some M&A transactions.

  7. 7.

    The CR3 is a concentration ratio representing the combined market share of the three largest firms in a sector.

  8. 8.

    In France, where non-profit organisations largely dominate the complementary insurance market, the number of M&As recorded in databases largely underestimates the phenomenon of concentration. Indeed, the status of non-profit actors prevents them from accessing traditional forms of M&A. The actors then opted for original forms of rapprochement outside the markets, creating more or less strong interrelationships between them (Abecassis et al. 2014). Unfortunately, the databases used do not identify these types of rapprochement.

  9. 9.

    The author points out the inaccuracy of these data. This is due to the discrepancies in the information provided by the source databases used.

References

  • Abecassis, P., Coutinet, N., & Domin, J.-P. (2014). Les principes mutualistes confrontés aux modalités de regroupement des organismes complémentaires d’assurance maladie. Recma/Revue Internationale de l’Économie Sociale, 93(331), 60–75.

    CrossRef  Google Scholar 

  • ACPR. (2016). Éléments d’analyse assurance non-vie des cycles en assurance non-vie. Paris: ACPR-Banque de France.

    Google Scholar 

  • André, C., Batifoulier, P., & Jansen-Ferreira, M. (2016). Health Care Privatization Processes in Europe: Theoretical Justifications and Empirical Classification. International Social Security Review, 69(1), 3–23.

    CrossRef  Google Scholar 

  • Barnes, B. G., Harp, N. L., & Oler, D. (2014). Evaluating the SDC Mergers and Acquisitions Database. Financial Review, 49(4), 793–822.

    CrossRef  Google Scholar 

  • Bernstein, D. (2011). Pays-Bas : la théorie de la concurrence régulée à l’essai. Les Tribunes de la santé, 30(1), 127–148.

    CrossRef  Google Scholar 

  • Bollaert, H., & Delanghe, M. (2015). Securities Data Company and Zephyr, Data Sources for M&A Research. Journal of Corporate Finance, 33, 85–100.

    CrossRef  Google Scholar 

  • Borscheid, P. (2013). La concentration de l’industrie de l’assurance en Allemagne. Entreprises et histoire, 72(3), 21–35.

    CrossRef  Google Scholar 

  • Coase, R. H. (1937). The Nature of the Firm. Economica, 4(16), 386–405.

    CrossRef  Google Scholar 

  • Coutinet, N., & Sagot-Duvauroux, D. (2003). Économie des fusions et acquisitions. Paris: La Découverte, coll. Repères.

    Google Scholar 

  • Defalvard, H., & Laguérodie, S. (2014). Les effets sur l’emploi de la concentration des Mutuelles de santé. Etude de cinq cas de fusions. Marne la Vallée: Chaire d’Économie Sociale et Solidaire.

    Google Scholar 

  • Desombre, N., Duverne, D., & de Montchalin, A. (2017). Les stratégies d’internationalisation en assurances. Revue d’économie financiere, 126(2), 51–64.

    CrossRef  Google Scholar 

  • Foubister, T., Thomson, S., Mossialos, E., & McGuire, A. (2006). Private Medical Insurance in the United Kingdom. Copenhagen: European Observatory on Health Systems and Policies.

    Google Scholar 

  • Harford, J. (2005). What Drives Merger Waves? Journal of Financial Economics, 77(3), 529–560.

    CrossRef  Google Scholar 

  • Holm, C.T. (2014). Anatomy of Recent European Industry—Level Merger Wave. Aarhus University: Business and Social Sciences.

    Google Scholar 

  • Huyghebaert, N., & Luypaert, M. (2010). Antecedents of Growth Through Mergers and Acquisitions: Empirical Results from Belgium. Journal of Business Research, 63(4), 392–403.

    CrossRef  Google Scholar 

  • Kober-Smith, A. (2010). “We Will Save the NHS”: la réforme du système de santé anglais sous le New Labour. Observatoire de la société britannique, 8, 69–86.

    CrossRef  Google Scholar 

  • Paris, V. (2014). L’impact de la crise économique sur les systèmes de santé des pays de l’OCDE. Médecine/sciences, 30(10), 910–915.

    CrossRef  Google Scholar 

  • Pearson, R. (2013). Mergers and Concentration in the UK Insurance Industry. Entreprises et histoire, 72(3), 7–20.

    CrossRef  Google Scholar 

  • Pons Pons, J. (2013). The Insurance Market in Spain: From Fragmentation to Concentration (1880–2010). Entreprises et histoire, 72(3), 36–54.

    CrossRef  Google Scholar 

  • Sagan, A., & Thomson, S. (2016a). Voluntary Health in Insurance in Europe: Role and Regulation. Copenhagen: World Health Organization, Regional Office for Europe.

    Google Scholar 

  • Sagan, A., & Thomson, S. (Eds.). (2016b). Voluntary Health in Insurance in Europe: Country Experience. Copenhagen: World Health Organization Regional Office for Europe.

    Google Scholar 

  • Shleifer, A., & Vishny, R. W. (2003). Stock Market Driven Acquisitions. Journal of Financial Economics, 70(3), 295–311.

    CrossRef  Google Scholar 

  • Smith, V. L. (1982). Markets as Economizers of Information: Experimental Examination of the “Hayek Hypothesis”. Economic Inquiry, 20(2), 165–179.

    CrossRef  Google Scholar 

  • Thomson, S., & Mossialos, E. (2009). Private Health Insurance in the European Union. London: London School of Economics and Political Science.

    Google Scholar 

  • Turquet, P. (2012). Réformes du financement des systèmes d’assurance maladie aux Pays-Bas, en Allemagne et en France: quelles conséquences en matière de couverture sociale et de redistribution ? Revue internationale de sécurité sociale, 65(1), 33–56.

    CrossRef  Google Scholar 

  • Weston, F. J., & Jawien, P. S. (1999). Perspectives on Mergers and Restructuring. Business Economics, 34(1), 29–33.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Philippe Abecassis .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2021 The Author(s)

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Abecassis, P., Coutinet, N. (2021). An Increasing Homogenisation of Private Health Insurers Under Solvency II?. In: Benoît, C., Del Sol, M., Martin, P. (eds) Private Health Insurance and the European Union. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-54355-6_5

Download citation