The Price Sensitivity of Health Plan Choice: Evidence from Retirees in the German Social Health Insurance

Wuppermann, Amelie C.; Bauhoff, Sebastian and Grabka, Markus M. (July 2014): The Price Sensitivity of Health Plan Choice: Evidence from Retirees in the German Social Health Insurance. Discussion Papers in Economics 2014-34

Abstract

We investigate two determinants of the price sensitivity of health plan demand: the size of the choice set and the salience of premium differences. Using variation in both features in the German Social Health Insurance (SHI) and information on health plan switches of retirees in the German Socio Economic Panel, augmented with information on individuals’ choice sets we find that retirees react less to potential savings from switching when they have more plans to choose from and when differences between premiums are less salient. Simplifying choices could save consumers money and improve the functioning of the health insurance market.

• Item Type: Paper
• Keywords: health plan choice, choice architecture, German social health insurance
• Faculties: Economics; Economics > Munich Discussion Papers in Economics
• Subjects: 300 Social sciences > 330 Economics
• JEL Classification: I11, D12, I18
• Language: English

References

Abaluck, J., Gruber, J., 2011. Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program. American Economic Review 101, 1180–1210. doi:10.1257/aer.101.4.1180

Andersen, H.H., Grabka, M.M., 2006. Kassenwechsel in der GKV 1997 - 2004. Profile - Trends - Perspektiven, in: Goepffarth, D., Gress, S., Jacobs, K., Wasem, J. (Eds.), Jahrbuch Risikostrukturausgleich 2006. pp. 145–189.

Angrist, J.D., Pischke, J.-S., 2009. Mostly harmless econometrics: an empiricist’s companion. Princeton University Press, Princeton.

Baicker, K., Chernew, M.E., Robbins, J.A., 2013. The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization. Journal of Health Economics 32, 1289–1300. doi:10.1016/j.jhealeco.2013.09.005

Barcellos, S.H., Wuppermann, A.C., Carman, K.G., Bauhoff, S., McFadden, D.L., Kapteyn, A., Winter, J.K., Goldman, D., 2014. Preparedness of Americans for the Affordable Care Act. PNAS 111, 5497–5502. doi:10.1073/pnas.1320488111

Basel, S., Schumacher, K., Zepke, K., 2011. KVdR und PflegeV – Krankenversicherung und Pflegeversicherung fuer Rentner, Gesetzliche Grundlagen und Erlaeuterungen, 16th edition. ed. Deutsche Rentenversicherung Bund, Berlin.

Bauhoff, S., 2012. Do health plans risk-select? An audit study on Germany’s Social Health Insurance. Journal of Public Economics 96, 750–759. doi:10.1016/j.jpubeco.2012.05.011

Buchmueller, T., 2006. Price and the health plan choices of retirees. Journal of Health Economics 25, 81–101. doi:10.1016/j.jhealeco.2005.06.001

Buchmueller, T.C., 2000. The health plan choices of retirees under managed competition. Health Services Research 35, 949–976.

Cameron, A.C., Gelbach, J.B., Miller, D.L., 2008. Bootstrap-Based Improvements for Inference with Clustered Errors. Review of Economics and Statistics 90, 414–427. doi:10.1162/rest.90.3.414

Chernew, M., DeCicca, P., Town, R., 2008. Managed care and medical expenditures of Medicare beneficiaries. Journal of Health Economics 27, 1451–1461. doi:10.1016/j.jhealeco.2008.07.014

Chetty, R., Looney, A., Kroft, K., 2009. Salience and Taxation: Theory and Evidence. American Economic Review 99, 1145–1177. doi:10.1257/aer.99.4.1145

Cohen, J., Dupas, P., 2010. Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment. Quarterly Journal of Economics 125, 1–45.

Dafny, L.S., Ho, K., Varela, M.J., 2013. Let Them Have Choice: Gains from Shifting Away from Employer-Sponsored Health Insurance and Toward an Individual Exchange. American Economic Journal: Economic Policy 5, 32–58.

Ericson, K., Starc, A., 2012. Heuristics and Heterogeneity in Health Insurance Exchanges: Evidence from the Massachusetts Connector. American Economic Review: Papers & Proceedings 102, 493–497.

Finkelstein, A., 2009. E-ztax: Tax Salience and Tax Rates. The Quarterly Journal of Economics 124, 969–1010. doi:10.1162/qjec.2009.124.3.969

Frank, R.G., Lamiraud, K., 2009. Choice, price competition and complexity in markets for health insurance. Journal of Economic Behavior & Organization 71, 550–562. doi:10.1016/j.jebo.2009.04.005

Handel, B.R., 2013. Adverse selection and switching costs in health insurance markets: When nudging hurts. American Economic Review 103, 2643–82. doi:10.1257/aer.103.7.2643

Heiss, F., Leive, A., McFadden, D., Winter, J., 2013. Plan selection in Medicare Part D: Evidence from administrative data. Journal of Health Economics 32, 1325–1344. doi:10.1016/j.jhealeco.2013.06.006

Heiss, F., McFadden, D., Winter, J., 2010. Mind the gap! Consumer perceptions and choices of Medicare Part D prescription drug plans, in: Wise, D.A. (Ed.), Research Findings in the Economics of Aging. Chicago University Press, Chicago and London, pp. 413–481.

Ketcham, J.D., Lucarelli, C., Miravete, E.J., Roebuck, M.C., 2012. Sinking, Swimming, or Learning to Swim in Medicare Part D. American Economic Review 102, 2639–2673. doi:10.1257/aer.102.6.2639

Kling, J.R., Mullainathan, S., Shafir, E., Vermeulen, L., Wrobel, M., 2012. Comparison Friction: Experimental Evidence from Medicare Drug Plans. Quarterly Journal of Economics 127, 199–235.

Loewenstein, G., 1999. Is more choice always better? Social Security Brief 7, 1–8.

Maestas, N., Schroeder, M., Goldman, D., 2009. Price Variation in Markets with Homogeneous Goods: The Case of Medigap. National Bureau of Economic Research Working Paper Series No. 14679.

McGuire, T.G., Bauhoff, S., 2007. A Decade of Choice: Tracking the German National Experience with Consumer Choice of Sickness Fund, in: Oberender, P., Straub, C. (Eds.), Auf Der Suche Nach Der Besseren Lösung. Nomos, Baden-Baden, pp. 145–159.

McWilliams, J.M., Afendulis, C.C., McGuire, T.G., Landon, B.E., 2011. Complex Medicare Advantage Choices May Overwhelm Seniors—Especially Those With Impaired Decision Making. Health Aff 30, 1786–1794. doi:10.1377/hlthaff.2011.0132

Schmitz, H., Ziebarth, N.R., 2013. In Absolute or Relative Terms? How Framing Prices Affects the Consumer Price Sensitivity of Health Plan Choice (IZA Discussion Paper No. 6241). Institute for the Study of Labor (IZA).

Schram, A., Sonnemans, J., 2011. How individuals choose health insurance: An experimental analysis. European Economic Review 55, 799–819. doi:10.1016/j.euroecorev.2011.01.001

Schut, F.T., Gress, S., Wasem, J., 2003. Consumer price sensitivity and social health insurer choice in Germany and The Netherlands. International Journal of Health Care Finance and Economics 3, 117–138.

Sinaiko, A.D., Hirth, R.A., 2011. Consumers, health insurance and dominated choices. Journal of Health Economics 30, 450–457. doi:10.1016/j.jhealeco.2010.12.008

Starc, A., 2011. Insurer pricing and consumer welfare: Evidence from Medigap (Working Paper). Wharton School at the University of Pennsylvania.

Strombom, B.A., Buchmueller, T.C., Feldstein, P.J., 2002. Switching costs, price sensitivity and health plan choice. Journal of Health Economics 21, 89–116. doi:10.1016/S0167- 6296(01)00124-2

Thomson, S., Foubister, T., Mossialos, E., 2009. Financing health care in the European Union Challenges and policy responses (No. Observation Studies Series 17). European Observatory on Health Systems and Policies.

Tversky, A., Shafir, E., 1992. Choice Under Conflict: The Dynamics of Deferred Decision. Psychological Science 3, 358 –361. doi:10.1111/j.1467-9280.1992.tb00047.x

Wagner, G.G., Göbel, J., Krause, P., Pischner, R., Sieber, I., 2008. Das Sozio-oekonomische Panel (SOEP): Multidisziplinäres Haushaltspanel und Kohortenstudie für Deutschland – Eine Einführung (für neue Datennutzer) mit einem Ausblick (für erfahrene Anwender). AStA Wirtschafts- und Sozialstatistisches Archiv 2, 301–328. doi:10.1007/s11943-008-0050-y