Will a means tested excess deductible lead to more efficient healthcare while guaranteeing universal access to healthcare?

The healthcare system performs a vital role in society. Yet in many countries the design of the healthcare system makes it inefficient and not universally accessible. In this paper the means tested excess deductible is researched as the possible solution to inefficiency and inaccessibility in healthcare. The means tested excess deductible is a deductible which is variable to both income and wealth, which influence the direct consumer cost of healthcare. When income and/or wealth increases so does the means tested excess deductible. The idea is that the means tested excess deductible incentives consumers to not overconsume healthcare, while allowing consumers with low income and wealth to still consume healthcare. This is likely to increase efficiency due to less overconsumption, it also improves universal access to healthcare since even consumers with low income and wealth can now consume healthcare. In order to research whether the means tested excess deductible is a solution to inefficiency and inaccessibility a theoretical framework is constructed, (behavioural) models are provided and empirics are analysed. The models and theoretical framework show that the efficiency of healthcare improves when the means tested excess deductible is implemented. Furthermore the universal access of healthcare is better guaranteed under a system using the means tested excess deductible. These improvements are most notable in comparison to the alternatives to the means tested excess deductible currently used: The fixed excess deductible and the insurance system (with no excess deductible). The means tested excess deductible better prevents overconsumption in comparison to both the fixed excess deductible and the insurance system. Furthermore access to healthcare is better guaranteed in comparison to the fixed excess deductible, and equally good as the insurance system. To empirically research the predicted effects of the means tested excess deductible, day fines are analysed since there is no data on the means tested excess deductible. Day fines are fines which height is based on an offender’s income and the severity of the violation. This shares similarities with the means tested excess deductible as both systems are relative to income. This analysis has not led to notable results, so empirically the means tested excess deductible is unproven. The mean tested excess deductible is implementable and most issues (privacy included) pose no direct threats to the implantation of the means tested excess deductible. Therefor the conclusion is that although empirical evidence is missing, the predicted effect of the means tested excess deductible is that it will improve healthcare efficiency and better guarantee universal access to healthcare.