Private Health Insurance Incentives for Disease Prevention: Opportunities, Barriers, and International Experience
DOI:
https://doi.org/10.52340/healthecosoc.2026.10.02.10Keywords:
private health insurance, disease prevention, insurance incentives, value-based insurance, chronic disease managementAbstract
Introduction: Disease prevention is increasingly recognized as an important mechanism for improving population health and reducing the financial burden associated with illness. Nevertheless, private health insurance frequently remains focused on short-term financial performance and the reimbursement of already incurred medical costs, whereas the benefits of preventive investments generally emerge over the medium and long term. This narrative review aimed to analyse the economic and institutional foundations of private health insurers’ involvement in disease prevention, the principal incentive mechanisms, implementation approaches, and existing barriers, with consideration of international experience and the Georgian context. Methods: The literature was identified through PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Reports and policy documents issued by international organizations and relevant Georgian institutions were also reviewed. Results: The findings indicate that private insurers’ incentives to invest in prevention are constrained by short-term contracts, enrollee turnover between insurers, fragmented health data, insufficient coordination with healthcare providers, and difficulties in measuring the financial returns of preventive programmes. Promising mechanisms include coverage of high-value preventive services without cost sharing, value-based insurance design, chronic disease management programmes, risk adjustment, digital monitoring, and targeted behavioural incentives. However, the effectiveness of these approaches depends on programme design, appropriate targeting, data quality, beneficiary participation, and systematic evaluation. Conclusion: For Georgia, the establishment of a minimum package of evidence-based preventive services, improved data integration, stronger long-term insurance incentives, protection against risk selection, and regular evaluation of preventive programmes are recommended. Aligning insurers’ financial interests with long-term population health objectives may enable private health insurance to move beyond passive reimbursement and become an active partner in disease prevention.
References
Arrow, K. J. (1963). Uncertainty and the welfare economics of medical care. The American Economic Review, 53(5), 941–973.
Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA—A scale for the quality assessment of narrative review articles. Research Integrity and Peer Review, 4, Article 5. https://doi.org/10.1186/s41073-019-0064-8
Centers for Medicare & Medicaid Services. (2024). The Affordable Care Act’s new rules on preventive care.
Chernew, M. E., Rosen, A. B., & Fendrick, A. M. (2007). Value-based insurance design. Health Affairs, 26(2), w195–w203. doi:10.1377/hlthaff.26.2.w195
Giles, E. L., Robalino, S., McColl, E., Sniehotta, F. F., & Adams, J. (2014). The effectiveness of financial incentives for health behaviour change: Systematic review and meta-analysis. PLOS ONE, 9(3), Article e90347. https://doi.org/10.1371/journal.pone.0090347
Giles, E. L., Robalino, S., Sniehotta, F. F., Adams, J., & McColl, E. (2015). Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods. Preventive Medicine, 73, 145–158. https://doi.org/10.1016/j.ypmed.2014.12.029
Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80(2), 223–255. doi:10.1086/259880
Herring, B. (2010). Suboptimal provision of preventive healthcare due to expected enrollee turnover among private insurers. Health Economics, 19(4), 438–448. doi:10.1002/hec.1484
Kirby, J. B., Davidoff, A. J., & Basu, J. (2016). The ACA’s zero cost-sharing mandate and trends in out-of-pocket expenditures on well-child and screening mammography visits. Medical Care, 54(12), 1056–1062. https://doi.org/10.1097/MLR.0000000000000610
Martínez-González, N. A., Berchtold, P., Ullman, K., Busato, A., & Egger, M. (2014). Integrated care programmes for adults with chronic conditions: A meta-review. International Journal for Quality in Health Care, 26(5), 561–570. https://doi.org/10.1093/intqhc/mzu071
Organisation for Economic Co-operation and Development. (2025). Health at a glance 2025: OECD indicators. OECD Publishing.
Patel, D. N., Lambert, E. V., da Silva, R., Greyling, M., Nossel, C., Noach, A., Derman, W., & Gaziano, T. (2010). The association between medical costs and participation in the Vitality health promotion program among 948,974 members of a South African health insurance company. American Journal of Health Promotion, 24(3), 199–204. doi:10.4278/090217-QUAN-68R2.1
Posadzki, P., Mastellos, N., Ryan, R., Gunn, L. H., Felix, L. M., Pappas, Y., Gagnon, M.-P., Julious, S. A., Xiang, L., Oldenburg, B., & Car, J. (2016). Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database of Systematic Reviews, 2016(12), Article CD009921. https://doi.org/10.1002/14651858.CD009921.pub2
Reif, J., Chan, D., Jones, D., Payne, L., & Molitor, D. (2020). Effects of a workplace wellness program on employee health, health beliefs, and medical use: A randomized clinical trial. JAMA Internal Medicine, 180(7), 952–960.
Solanki, G., Schauffler, H. H., & Miller, L. S. (2000). The direct and indirect effects of cost-sharing on the use of preventive services. Health Services Research, 34(6), 1331–1350.
Song, Z., & Baicker, K. (2019). Effect of a workplace wellness program on employee health and economic outcomes: A randomized clinical trial. JAMA, 321(15), 1491–1501. https://doi.org/10.1001/jama.2019.3307
Stock, S., Schmidt, H., Büscher, G., Gerber, A., Drabik, A., Graf, C., Lüngen, M., & Stollenwerk, B. (2010). Financial incentives in the German statutory health insurance: New findings, new questions. Health Policy, 96(1), 51–56. doi:10.1016/j.healthpol.2009.12.015
van de Ven, W., Hamstra, G., van Kleef, R., Reuser, M., & Stam, P. (2023). The goal of risk equalization in regulated competitive health insurance markets. The European Journal of Health Economics, 24(1), 111–123. doi:10.1007/s10198-022-01457-7
World Health Organization. (2025a). Noncommunicable diseases.
World Health Organization Regional Office for Europe. (2025a). Governance of the private health sector in Georgia: A situation analysis using WHO’s Progression Pathway for Governance of Mixed Health Systems. World Health Organization.
World Health Organization Regional Office for Europe. (2025b). Purchasing health care from the private sector: A primer for countries in the WHO European Region. World Health Organization.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles published in the Health Policy, Economics and Sociology are licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License. You are free to share and adapt the material for any purpose, even commercially, provided you give appropriate credit to the original author(s) and the source.
ჟურნალი უზრუნველყოფს დაუყოვნებელ ღია წვდომას მის შინაარსზე იმ პრინციპით, რომ კვლევის შედეგების საჯაროდ ხელმისაწვდომობა ხელს უწყობს ცოდნის გლობალურ გაცვლას.
ჟურნალში გამოქვეყნებული სტატიები ვრცელდება Creative Commons Attribution 4.0 International (CC BY 4.0) ლიცენზიით. თქვენ უფლება გაქვთ გაავრცელოთ ან გამოიყენოთ მასალა ნებისმიერი (მათ შორის კომერციული) მიზნით, იმ პირობით, რომ მიუთითებთ ავტორ(ებ)ს და პირველწყაროს.
