Optionen der Weiterentwicklung des Risikostrukturausgleichs in der GKV

The system of risk equalization payments among German Statutory Sickness Funds is currently under intensive political debate. While some participants claim that the enormous size of the equalization payments are detrimental to effective competition among funds, others argue that there are still funds which engage heavily in risk selection and are thereby able to keep their contribution rates low. In this paper the major options for a modification of the current system are analyzed both theoretically and empirically with respect to their capacity to diminish the spread of contribution rates, while preserving incentives for an efficient delivery of health care services. In particular, we examine the inclusion of additional risk adjusters in the equalization formula and the formation of a high-risk pool. The data suggest that it is indeed possible to improve the formula without diminishing the incentives for efficiency if the risk adjusters "income" and "marital status" are included.