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Health Insurance Plan Choice and Switching  

Joachim Winter and Amelie Wuppermann

Choice of health insurance plans has become a key element of many healthcare systems around the world along with a general expansion of patient choice under the label of “Consumer-Directed Healthcare.” Allowing consumers to choose their insurance plan was commonly associated with the aim of enhancing competition between insurers and thus to contribute to the efficient delivery of healthcare. However, the evidence is accruing that consumers have difficulties in making health insurance decisions in their best interest. For example, many consumers choose plans with which they spend more in terms of premiums and out-of-pocket costs than in other available options. This has consequences for the individual consumer’s budget as well as for the functioning of the insurance market. The literature puts forward several possible reasons for consumers’ difficulties in making health insurance choices in their best interest. First, consumers may not have a sufficient level of knowledge of insurance products; for example, they might not understand insurance terminology. Second, the environment or architecture in which consumers make their decision may be too complicated. Health insurance products vary in a large number of features that consumers have to evaluate when comparing options, introducing search or hassle costs. Third, consumers may be prone to psychological biases and employ decision-making heuristics that impede good choices. For example, they might choose the plan with the cheapest premium, ignoring other important plan features that determine total cost, such as copayments. There is also evidence that consumer education programs, simplification of the choice environment, or introducing nudges such as setting smart defaults facilitate consumer decision making. Despite recent progress in our understanding of consumer choices in health insurance markets, important challenges remain. Evidence-based healthcare policy should be based on an evaluation of whether different interventions aimed at facilitating consumer choices result in welfare improvements. Ultimately, this requires measuring consumer utility, an issue that is vividly debated in the literature. Furthermore, welfare calculations necessitate an understanding of how interventions will affect the supply of health insurance, including supply reactions to changes in demand. This depends on the specific regulatory setting and characteristics of the specific market.


International Prices and Exchange Rate Pass-Through  

Ehsan U. Choudhri

Exchange rates often display sudden and large changes. There is considerable interest in examining how these changes affect prices, especially import and consumer prices. Exchange rate pass-through measures the responsiveness of the price of a basket of goods to changes in the exchange rate and is defined as the elasticity of the price of the basket (expressed in home currency) with respect to the exchange rate (defined as the price of foreign currency). The pass-through estimates vary across product groups, countries, and time periods, but a general finding is that pass-through tends to be significantly less than one, which implies that prices do not fully respond to a foreign currency appreciation. Pass-through to export prices tends to be smaller than pass-through to import prices. Pass-through to consumer prices is lower than both import and export price pass-through and is generally very small. One explanation of pass-through evidence focuses on the role of nominal rigidities (infrequent changes in prices set in home or foreign currency). Another explanation emphasizes the importance of markup variation in response to exchange rate changes. In models with nominal rigidities, one important issue is whether exporting firms set prices in their country’s currency (producer’s currency) or importing country’s currency (consumer’s currency). If prices are sticky in producer’s currency, flexible exchange rates are preferable as they allow for desirable relative price adjustment. On the other hand, if prices are sticky in consumer’s currency, exchange rate flexibility is not as helpful in adjusting prices and fixed exchange rates are superior. The standard model where markup is constant and all firms (at home and abroad) use either producer or consumer currency pricing is not consistent with typical estimates of pass-through to import and export prices. To explain this evidence, the standard model needs to be modified to allow for variable markup and/or a hybrid model of currency choice where some firms set prices in producer’s and others in consumer’s currency. In the case of the hybrid model, the welfare difference between fixed and flexible exchange rates is not as stark as in the pure cases of currency choice and is likely to be small. Another issue of much interest is whether inflationary environment can affect pass-through, especially to consumer prices. Inflationary environment can influence pass-through to import and consumer prices through several channels, such as persistence of costs and frequency of price change. Empirical evidence shows that pass-through to consumer prices is related to the level and variability of inflation across countries and time periods and is lower in an environment with low and stable inflation. This evidence suggests that a monetary policy regime that targets low inflation will produce a low pass-through environment, which would dampen the price effects of exchange rate changes.