A new prevention paradox: The trade-off between reducing incentives for risk selection and increasing the incentives for prevention for health insurers

► Improved risk equalization is important to reduce incentives for risk selection by health insurers. ► We describe insurers' financial incentives for risk selection in relation to recent improvements in Dutch risk equalization. ► We estimated lifetime costs and benefits for Dutch health insurers for smoking, obese and healthy living individuals. ► Insurers can expect different health care costs and risk equalization revenues for healthy living, smoking and obese people. ► Healthy living individuals are only slightly more financially attractive for insurers than smoking and obese individuals.