Highly educated people of 35-44 years old in the risk equalization

The risk equalization model for health care aims to create a level playing field for health insurers and prevent them from applying risk selection. For a predictably profitable (healthy) insured person a health insurer receives a lower amount from the Zorgverzekeringsfonds (Health Insurance Fund), for a predictably loss-making (sick) insured person a health insurer receives a higher amount.

Highly educated people have lower health care costs than people with a low education level. The risk equalization model therefore includes a coefficient for highly educated insured people of ages 18-34. Due to incompleteness of the education records, expansion to the age group of 35-44 years old has not been possible up until now. This study shows that as of next year a coefficient for highly educated people of 35-44 years old can be included in the risk equalization model. By then the education records for this age group will be complete. This coefficient has not yet been incorporated into the equalization contribution for 2017. In 2017 insurers will therefore receive €42 too much for every highly educated person of age 35-44 that they insure, and €15 too little for every lower educated person of age 35-44 that they insure. In calculating this overcompensation, only the costs for somatic care and medical mental health care have been taken into account. The deductible and the costs for long-term mental health care have been disregarded.