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No-claim settlement can be an alternative to the deductible

Published: 26th February 2024 Last updated: 26th February 2024

The deductible and patient costs are important topics in the political debate in the Netherlands. According to health economics professor Martin Salm, a viable alternative could be the no-claim scheme, which was previously abolished in the Netherlands. He researched how no-claim refunds influence claiming behavior at a large German health insurer. Claims were found to decrease on average by eight percent.

Cost-sharing in health insurance is a current topic in Dutch politics. On average, patients in the Netherlands pay about 20 percent of total healthcare costs out of pocket. An important form of cost-sharing in the Netherlands is the mandatory annual deductible, which is currently 385 euros.

This deductible is controversial in the political debate in the Netherlands, raising the question of whether viable alternatives exist. Martin Salm: ‘Such an alternative could be no-claim refunds that were applied in the Netherlands in 2006 and 2007, before the mandatory deductible was introduced in 2008. No-claim refunds are cost-containment instruments that involve a repayment scheme depending on one or more claim-free years.’

Customers responded to the reimbursement policy by reducing claims on average by eight percent

Martin Salm


Claim behavior

Martin Salm and his co-authors Daniel Avdic, Martin Karlsson, and Simon Decker investigated people's response to a no-claim discount from a German health insurer. In addition to the no-claim discount, there was also a policy that increased reimbursement for certain insurance plans while reimbursement for other similar plans remained unchanged.

The researchers found that customers responded to the reimbursement policy by reducing claims on average by eight percent. The effect persisted for several years, even after the increase in reimbursement was partially withdrawn. A reduction in healthcare utilization in the present did not lead to higher costs in later years. 

Customers with a health risk slightly below average had more to gain from this policy, and they responded more strongly. Clients reduced claims across a broad range of healthcare services, and reductions in claims were not limited to treatments of questionable medical benefit


Martin Salm: ‘This research contributes to the debate on cost-sharing for patients in the Netherlands by carefully examining the effects of a possible alternative to the current deductible policy. Our study concludes that no-claim refunds achieve the objectives of cost-sharing but without some of the known disadvantages of deductibles. For example, they pose fewer challenges for clients who do not have enough savings to pay for an  unexpected deductible bill, and they may encounter less resistance from clients who reject deductibles.’

The study ‘No-claim refunds and healthcare use’ by Martin Salm, Daniel Avdic, Simon Decker and Martin Karlsson was published in the scholarly journal Journal of Public Economics.