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Reaching goals of managed competition? The challenge of free health plan choice.

Bes, R., Crufs, E., Groenewegen, P., Jong, J. de. Reaching goals of managed competition? The challenge of free health plan choice. European Journal of Public Health: 2015, 25(spl. 3) 476. Abstract: 8th European Public Health Conference: "Health in Europe - from global to local policies, methods and practices". 14-17 oktober 2015 in Milan.
Introduction
In the last decades, several countries have implemented a health care system based on managed competition. In such a system, health insurers are supposed to be prudent buyers of care on behalf of their enrolees. Selective contracting and channelling patients to contracted care providers is important for health insurers to be able to negotiate about quality and price with providers and thus reach the goals of the health care system. It is crucial that enrolees who actually need care choose restrictive health plans, since otherwise health insurers are not able to channel patients to contracted providers. Restrictive health plans are cheaper than non-restrictive health plans, but enrolees generally resent restrictions in provider choice. The aim of this study is to explain enrolees’ choice for a restrictive health plan in exchange for a lower premium.

Methods
In 2014 a survey was conducted on members of the Insurance panel (response 78%; n = 3.417). In this survey enrolees are confronted with three choice sets, where they had to choose between two health plans.

Results
The results show that 37,4% of enrolees are willing to choose a restrictive health plan in exchange for a lower premium. When the restrictive health plan option also included a longer travel time, the number of people choosing the restrictive health plan decreased to 22%. Enrolees who choose a restrictive health plan are younger and healthier than enrolees who prefer a nonrestrictive health plan. Also, lower income individuals more often choose a restrictive health plan.

Conclusions: This study shows that in the current situation, restrictive health plans are unattractive for older and more unhealthy enrolees. This means that enrolees who use care will not be likely to choose a restrictive health plan and, therefore, health insurers will not be able to channel them to contracted care providers. This undermines reaching the goals of the health care system based on managed competition.

Key messages: For a health care system based on managed competition to work, it is very important that enrollees who use care choose a restrictive health plan. Yet, they are least likely to purchase such a plan. This limits the ability of health insurers to channel patients to contracted providers and thus the ability of insurers to negotiate with care providers about price and quality of care.