caa a22 4500 606167560 CHVBK 20210128100703.0 cr unu---uuuuu 210128e20150601xx s 000 0 eng 10.1007/s10754-015-9163-3 doi (NATIONALLICENCE)springer-10.1007/s10754-015-9163-3 Can universal access and competition in long-term care insurance be combined? [Elektronische Daten] [Pieter Bakx, Frederik Schut, Eddy van Doorslaer] In countries with a public long-term care (LTC) insurance scheme administered by multiple non-competing insurers, these insurers typically lack incentives for purchasing cost-effective LTC because they are not at risk for LTC expenses. Plans to introduce these incentives by allowing competition among risk bearing LTC insurers are likely to jeopardize universal access. Combining universal access and competition among risk bearing LTC-insurers requires an adequate system of risk adjustment. While risk adjustment is now widely adopted in health insurance, LTC-specific features cause uncertainty about the feasibility of risk adjustment for LTC insurance. We examine the feasibility of appropriate risk adjustment in LTC insurance by using a rich set of linked nationwide Dutch administrative data. As expected, prior LTC use and demographic information are found to explain much of the variation in individual LTC expenses. However, we find that prior health care expenditures are also important in reducing predicted losses for subgroups of health care users. Nevertheless, incentives for risk selection against some easily identifiable subgroups persist. Moreover, using prior utilization and expenditure as risk adjusters reduces incentives for efficiency, creating a trade-off between equity and efficiency. To ease this trade-off, data on individuals' underlying needs for LTC are required. The Author(s), 2015 Risk adjustment nationallicence Long-term care nationallicence Managed competition nationallicence Public insurance nationallicence Bakx Pieter Institute of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands aut Schut Frederik Institute of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands aut van Doorslaer Eddy Institute of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands aut International Journal of Health Economics and Management Springer US; http://www.springer-ny.com 15/2(2015-06-01), 185-213 2199-9023 15:2<185 2015 15 10754 https://doi.org/10.1007/s10754-015-9163-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10754-015-9163-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bakx Pieter Institute of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Schut Frederik Institute of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- van Doorslaer Eddy Institute of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands aut NATIONALLICENCE 773 0- International Journal of Health Economics and Management Springer US; http://www.springer-ny.com 15/2(2015-06-01), 185-213 2199-9023 15:2<185 2015 15 10754