Demand-side strategies to deal with moral hazard in public insurance for long-term care

Pieter Bakx, Dov Chernichovsky, Francesco Paolucci, Erik Schokkaert, Maria Trottmann, Juergen Wasem, Frederik Schut

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Moral hazard in public insurance for long-term care may be counteracted by strategies influencing supply or demand. Demand-side strategies may target the patient or the insurer. Various demand-side strategies and how they are implemented in four European countries (Germany, Belgium, Switzerland and the Netherlands) are described, highlighting the pros and cons of each strategy. Patient-oriented strategies to counteract moral hazard are used in all four countries but their impact on efficiency is unclear and crucially depends on their design. Strategies targeted at insurers are much less popular: Belgium and Switzerland have introduced elements of managed competition for some types of long-term care, as has the Netherlands in 2015. As only some elements of managed competition have been introduced, it is unclear whether it improves efficiency. Its effect will depend on the feasibility of setting appropriate financial incentives for insurers using risk equalization and the willingness of governments to provide insurers with instruments to manage long-term care.

Original languageEnglish
Pages (from-to)170-176
Number of pages7
JournalJournal of Health Services Research and Policy
Issue number3
StatePublished - 1 Mar 2015


  • Long-term care
  • Managed competition
  • Public insurance
  • Risk adjustment

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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