International Lesson on Insurance Exchanges

While health insurance exchanges are relatively new to the United States, several European countries, including Switzerland, the Netherlands, Germany and Belgium have had exchanges or exchange-like features in their coverage systems.   (HA Article)   Experiences in these countries might help with the design of exchanges here.  In Switzerland and the Netherlands, the exchanges are similar to those being developed in the US under the reform law; there is an individual mandate, there are minimum benefits and everyone basically gets charged the same by an insurer, although insurers may have different prices for the same benefits.  Supposedly this system puts pressure on insurers to keep prices and utilization under control to have a competitive price, and helps consumers shop for the plan that offers the best combination of features for them.  Both countries have low rates of switching of plans, but the Swiss experience wide variations in premiums for the same benefit structure while there is little difference in premiums in the Netherlands.  The authors summarize important lessons from the experience in these countries as using sophisticated risk adjusters to avoid insurers engaging in selection practices; having a comprehensive system of both subsidy calculation for lower income people and a mechanism to ensure they enroll and pay whatever their share of costs is; finding mechanisms to help insurers be able to keep provider prices at a reasonable level and ensuring that there is a high level of transparency in regard to costs and prices for providers and insurers.