Health economists have studied the determinants of the expected value of health status as a function of medical and non-medical inputs, often finding small marginal effects of the former. However, medical inputs may have an additional benefit in the form of a reduced variability of health status. Using the standard deviation of life expectancy in 24 OECD countries between 1960 and 2005, a 10 percent increase of health care expenditure is associated with a decrease of an estimated 0.42 percent. Willingness to pay for such a reduction of uncertainty may well exceed the extra health care expenditure in the United States and Switzerland. This implies that even in these two countries with very high health care expenditure per capita, flat-of-the-curve medicine need not be wasteful.JEL-Classification: I12, J10

This paper sheds light on some unexpected consequences of health insurance regulation that may pose a big challenge to insurers' risk management. Because mandated uniform contributions to health insurance trigger risk‐selection efforts, risk adjustment (RA) schemes become necessary. A good deal of research into the optimal RA formula has been performed. A recent proposal in Switzerland has been to add ‘Hospitalization exceeding three days during the previous year’ as an indicator of high risk. Applying the new formula to an individual Swiss health insurer, its payments into the RA scheme are predicted to increase substantially, reaching up to 13% of premium income. Its mistake had been to implement Managed Care successfully, resulting in low rates of hospitalization. The expected risk management response is to extend hospital stays beyond three days, contrary to stated policy objectives.Health Insurance, Regulation, Risk Management, Risk Adjustment, I18, L51, H51,

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Summary This paper applies the five standard economic performance criteria to gauge the contribution of Managed Care (MC) to the performance of three healthcare systems, viz. Germany, the Netherlands, and Switzerland. The criteria are (1) matching of consumer preferences, (2) technical efficiency, (3) adaptive capacity, (4) dynamic efficiency, and (5) a rent-free distribution of income that provides incentives for producers to attain criteria (1) through (4). Being insurance-based, the German, Dutch, and Swiss healthcare systems comprise three contractual relationships that can be judged in the light of these criteria. The maximum contribution of MC to the performance of the healthcare system is found for the Netherlands followed by Switzerland. The Independent Practice Associations representing MC in the Netherlands, and the Health Maintenance Organizations representing MC in Switzerland score 15 respectively 6 out of 30 points. By way of contrast, the contribution of the Disease Management Programs to the performance of the German healthcare system remains limited (3 out of 30 points).