THE PRICING RULES OF MUTUAL HEALTH INSURERS: SUPPORT FOR A MARKET REPRESENTATION OF HEALTH INSURANCE?

Abstract

The article provides explanations on the pricing rules for individual contracts offered by mutual insurance companies. Mutual health insurance companies are special organizations in the supplementary health insurance sector; they are not-for-profit organizations that claim the presence of solidarity values in their practices.The existing literature in economics on health insurance pricing shows that mutuals tend to offer more contracts with redistribution mechanisms. The objective of the article is to understand why and how mutuals can implement a redistribution policy in their contracts via their pricing system. To do so, the article follows the work in economics of conventions and considers that pricing rules reveal tensions in mutual health insurance. A mixed methodology is used, combining quantitative and qualitative approaches. Based on a DREES survey of the most popular contracts taken out with supplementary health insurance organizations, the statistical treatment consists of constructing a classification of individual contracts based on their pricing methods. The qualitative analysis takes the form of semi-directive interviews with mutual insurance companies.The article presents three main results. Firstly, the most redistributive pricing rules are introduced in specific segments (civil servants and former company employees). Secondly, as the pricing practices of mutual health insurers converge with those of insurance companies, the article shows the diversity of pricing rules in these organizations. Finally, solidarity is a constitutive principle of mutuals before being a redistribution mechanism. There is a plurality of representations associated with solidarity: assistance, redistribution and participation in a collective. The solidarity argument is used to justify both redistributive pricing rules and assistance practices.