Abstract
This chapter takes a European perspective to explores the main consequences of EU legislation on the strategic behaviour of private health insurers. Using quantitative data, it shows how changes led by the EU legislation in the insurers’ environment, in particular the public disengagement from health coverage, are creating a favourable environment for the emergence or development of more or less profitable national markets for private health insurance. Thus, the analysis of mergers and acquisitions (M&A) carried out in the private health insurance sector during the 2000s and 2010s and of their determinants shows how non-profit entities dominating the field in several EU countries tend to mimic for-profit insurers in terms of strategies and behaviours—with potential consequences for the provision of health benefits.
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Notes
- 1.
This corresponds to the expenses that patients have to pay when no public or private health insurance system covers the total cost. It includes the share of expenditures paid by households to caregivers, including informal payments.
- 2.
However, these expenditures fell slightly in some countries, particularly in the Czech Republic (−1.3%) and Slovenia (−1.1%).
- 3.
Except Luxembourg, for which the data cannot be used.
- 4.
Behavioural analysis is not studied in this work. It is assumed that the European countries selected are economically close enough to each other not to consider significant differences in the behaviour of the insurers on the health insurance markets, ceteris paribus.
- 5.
The diversity of health systems does not allow this indicator to be constructed on the basis of a distinction between private and public insurance. This makes no sense, for example, when private insurers participate in compulsory health coverage (the Netherlands and Germany). To overcome this difficulty, only voluntary private insurance is taken into account here.
- 6.
The Mergr database (Mergr.com) has been partially used as a complement or confirmation of some M&A transactions.
- 7.
The CR3 is a concentration ratio representing the combined market share of the three largest firms in a sector.
- 8.
In France, where non-profit organisations largely dominate the complementary insurance market, the number of M&As recorded in databases largely underestimates the phenomenon of concentration. Indeed, the status of non-profit actors prevents them from accessing traditional forms of M&A. The actors then opted for original forms of rapprochement outside the markets, creating more or less strong interrelationships between them (Abecassis et al. 2014). Unfortunately, the databases used do not identify these types of rapprochement.
- 9.
The author points out the inaccuracy of these data. This is due to the discrepancies in the information provided by the source databases used.
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Abecassis, P., Coutinet, N. (2021). An Increasing Homogenisation of Private Health Insurers Under Solvency II?. In: Benoît, C., Del Sol, M., Martin, P. (eds) Private Health Insurance and the European Union. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-54355-6_5
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