Since 1995 Belgian sickness funds are partially financed through a risk adjustment system and are held partially financially responsible for the difference between their actual and their risk-adjusted expenditures. However, they did not get the necessary instruments for exerting a real influence on expenditures and the health insurance market has not been opened for new entrants. At the same ti...

Germany’s Statutory Health Insurance (SHI) more or less dates back to the late 19 century when Chancellor Bismarck implemented a forerunner of the present system to combat social unrest. Without any doubt, this was a great achievement for the social welfare state in Germany, of which the SHI is one pillar – and the SHI has proved to be remarkably stable ever since, both against reform efforts a...

The article by The Physicians' Working Group for Single-Payer National Health Insurance in this issue of THE JOURNAL should re-energize the much needed debate on universal health insurance. More than 40 million Americans lack health insurance and nearly 60 million are without health insurance for a portion of the year. Employers face rising health insurance premiums, and their employees face in...

The German statutory health insurance market was exposed to competition in 1996. To limit direct risk selection the regulator required open enrollment. As the risk compensation scheme, introduced in 1994, is highly incomplete, substantial incentives for risk selection exist. Due to their low premiums, company-based sickness funds have been able to attract a lot of new members. We analyze, using...

Incomplete Risk Adjustment and Adverse Selection in the German Public Health Insurance System by Thomas Knaus and Robert Nuscheler The German statutory health insurance market was exposed to competition in 1996. To avoid adverse selection, a prospective risk compensation scheme was introduced in 1994. Due to their low contribution rates, company-based sickness funds were able to attract a lot o...

Under Oregon’s 1989 legislative package, the Medicaid portion of the Oregon Health Plan was only one of its two critical pieces. The other was the requirement that employers provide insurance to employees, with the prioritized list as the minimal benefit package. Small businesses lobbied for the repeal of this part of the legislation, and on January 1, 1996, it died. Gone was the hope of nearly...