The October issue of Health Affairs includes several articles about global health, including lessons United States consumers and policymakers can glean from other countries' past experiences with their own health exchanges. This comes at a time when the United States is gearing up for the next open enrollment season of the Affordable Care Act (ACA) health Marketplaces.

One of the October studies, by Wynand van de Ven of the Netherland's Erasmus University Rotterdam and coauthors, examines how several European countries have addressed the problem of risk selection.

The study notes errors made by a few European legislators and details strategies taken to reduce risk selection, especially through quality skimping, as well as some of the trade-offs made.

To prevent risk selection that threatens access to quality care for underpriced high-cost patients, the authors recommend that US policy makers allow insurers more flexibility in setting premium rates and replace the current premium band on age with a generic premium band.

They conclude that policy makers need to understand the complexities of regulating competitive health insurance markets.