Yesterday, I spoke about the Swiss health care system. One of the main attributes of this system is that patients are allowed to choose from any health care plan and the health insurers can not refuse to cover them. Further, since the insurance benefit is mandated by law, there is very little quality difference between plans. Only 8% of health plans restrict provider choice in any way.
An NBER working paper by Frank and Lamiraud analyzes how the number of firms offering health insurance in Switzerland has affected price dispersion and expected price.
Economists generally believe that when more firms/products enter the market, this will increase the probability that a superior health insurer will be available to the public. However, when more products enter the market, search costs increase. Thus, it is theoretically possible for more health insurance offerings to decrease utility.
A paper by Janssen and Moraga-Gonzales (2004) show that an the welfare impact of an increase in the number of sellers depends on the consumers’ search intensity. When consumers search with low intensity, having more firms will reduce search, will not affect expected price and will to greater price dispersion. One can think that inexpensive and/or infrequently purchased items would fall in to this category. When consumers search with high intensity, an increase in the number of firms will increase searching and decrease prices. In the 401(k) market, when employees are offered more than 10 choices, there are reductions in consumer responses (i.e.: less investment switching occurs).
Frank and Lamiraud aim to analyze how the number of firms affects insurance choice in Switzerland. They use a panel survey from the Federal Office for Social Insurance (OFAS). It contains a sample of 2152 individuals and asks about their insurance coverage between 1997 and 2000. Yearly premiums are available at the Federal Office for Public Health (OFSP) website. While there was consolidation in the health insurance market among firms, the average number of health plans offered per canton increased from 39 in 1998 to 52 in 2003. The number of people switching plans was 4.8% in 1997, 5.4% in 1998, 2.7% in 1999 and 2.1% in 2000.
How do people choose their plan?
…40% of people choose a health plan following their parents’ and friends’ choices, and what they see as tradition. Furthermore, as many as 25% individuals declare that they do not strive to pick the health insurance plan with the lowest premium. A substantial number of people explicitly report staying with their health plan based on habit (13.5%) or because they are satisfied with their arrangement (79%)
What do the authors conclude from the data?
First, we show that consumers that switch health plan pay 15% to 16% less in health insurance premiums per month holding ceteris paribus. Second, we show that among consumers expressing dissatisfaction with their health plans those in markets with fewer choices are more likely to express intent to switch. Finally, consumers that used an agent to help them purchase insurance consistently paid significantly lower premiums. This set of results suggests that “mistakes may have been made”.
Despite what orthodox economic theory states, no market is perfect. Understanding these market imperfection imparts important knowledge for economists and health policy makers.
- Richard Frank, Karine Lamiraud, 2008. “Choice, Price Competition and Complexity in Markets for Health Insurance,” NBER Working Paper #13817.