大西洋两岸健康保险市场的规制竞争
Regulated Competition in Health Insurance Markets on Two Sides of the Atlantic
Journal of Economic Perspectives · 2026 · [{"name": "Lukas Kauer", "affiliation": ["University of Lucerne", "University of Teacher Education Lucerne"]}, {"name": "Thomas G. McGuire", "affiliation": ["National Bureau of Economic Research"]}, {"name": "Sonja Schillo", "affiliation": ["Federal Office for Information Security"]}, {"name": "Richard C. van Kleef", "affiliation": ["Erasmus University Rotterdam"]}]
中文摘要
许多高收入国家通过个人健康保险并结合保险方之间受监管的竞争来实施其全民健康保险政策。在公共干预的支持下，受监管的竞争原则上可以应对健康保险中的市场失灵，并缓和疾病经济后果方面以及支付健康保险能力方面的部分不平等。我们将德国、荷兰和瑞士的国家制度与美国健康保险市场（Marketplaces）进行比较，它们均采用了不同版本的受监管竞争。尽管这些制度表现出诸多相似之处（例如开放参保、带补贴的社区评级保费、综合性福利包、风险调整），我们仍聚焦于三项主要差异及其对市场运行的影响：（1）强制且普遍适用，相对于自愿且部分适用（仅适用于健康保险的一个部门）；（2）保险方利润导向程度的高低；（3）依赖市场还是依赖监管来控制成本。
Abstract
Many high-income countries implement their policy of universal health insurance by individual health insurance in combination with regulated competition among insurers. Supported by public intervention, regulated competition can, in principle, address market failures in health insurance and smooth out some inequities in the financial consequences of ill health and in the ability to pay for health insurance. We compare the national systems in Germany, the Netherlands, and Switzerland to the US Marketplaces, all of which use versions of regulated competition. While they show many similarities (for example, open enrollment, community-rated premiums with subsidies, comprehensive benefit package, risk adjustment), we focus on three major differences and their implications for market functioning: (1) mandatory and universal versus voluntary and partial (applying to only one sector of health insurance); (2) greater or lesser profit orientation of insurers; and (3) reliance on markets or regulation to contain costs.