Effects Of Private Health Insurance Research Articles

Effects of private health insurance on waiting time in public hospitals.

The Australian government pays $6.7 billion per year in rebates to encourage Australians to purchase private health insurance (PHI) and an additional $6.1 billion to cover services provided in private hospitals. What is the justification for large government subsidies to a private industry when all Australians already have free coverage under Medicare? The government argues that more people buying PHI will relieve the burden on the public system and may reduce waiting times. However, the evidence supporting this is sparse. We use an instrumental variable approach to study the causal effects of higher PHI coverage in the area on waiting times in public hospitals in the same area. The instrument used is area-level average house prices, which correlate with average income and wealth, thus influencing the purchase of PHI due to tax incentives, but not directly affecting waiting times in public hospitals. We use 2014-2018 hospital admission and elective surgery waiting list data linked at the patient level from the Victorian Center for Data Linkage. These data cover all inpatient admissions in all hospitals in Victoria (both public and private hospitals) and those registered on the waiting list for elective surgeries in public hospitals in Victoria. We find that one percentage point increase in PHI coverage leads to about 0.34days (or 0.5%) reduction in waiting times in public hospitals on average. The effects vary by surgical specialities and age groups. However, the practical significance of this effect is limited, if not negligible, despite its statistical significance. The small effect suggests that raising PHI coverage with the aim to taking the pressure off the public system is not an effective strategy in reducing waiting times in public hospitals. Alternative policies aiming at improving the efficiency of public hospitals and advancing equitable access to care should be a priority for policymakers.

An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service.

In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses. This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020. Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million. A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.

Effects of private health insurance on healthcare services during the MERS Pandemic: Evidence from Korea

This study investigates how private health insurance impacted healthcare services during the MERS pandemic in Korea. Using the Korea Health Panel Study (KHPS), this study examines the difference in healthcare utilization between insured and uninsured individuals during the pandemic. If insured individuals use fewer healthcare services than the uninsured during the MERS pandemic, it could be evidence of moral hazard. During the MERS outbreak, the probability of outpatient medical services utilization was lower by 19 % than during non-pandemic periods. All individuals decreased the number of outpatient visits by 7 %. Insured individuals reduced outpatient visits more than the uninsured in response to the MERS pandemic. The increased outpatient utilization by private health insurance could be attributed to both moral hazard and adverse selection. However, given that people with poor health cannot enroll in private health insurance due to the insurance company's screening process, moral hazard leads to increase healthcare utilization rather than adverse selection.

Effects of private health insurance on medical expenditure and health service utilization in South Korea: a quantile regression analysis

BackgroundDespite universal health insurance, South Korea has seen a sharp increase in the number of people enrolled in supplemental private health insurance (PHI) during the last decade. This study examined how private health insurance enrollment affects medical expenditure and health service utilization.MethodsUnbalanced panel data for adults aged 19 and older were constructed using the 2016–2018 Korea Health Panel Survey. Quantile regression for medical cost, and quantile count regression for health service utilization were utilized using propensity score-matched data. We included 17 variables representing demographic, socioeconomic, and health information, as well as medical costs and use of outpatient and inpatient care.ResultsWe discovered that PHI enrollees’ socioeconomic and health status is more likely to be better than PHI non-enrollees’. Results showed that private health insurance had a greater effect on the lower quantiles of the conditional distribution of outpatient costs (coefficient 0.149 at the 10th quantile and 0.121 at the 25th quantile) and higher quantiles of inpaitent care utilization (coefficient 0.321 at the 90th quantile for days of hospitalization and 0.076 at the 90th quantile for number of inpatient visits).ConclusionsPHI enrollment is positively correlated with outpatient costs and inpatient care utilization. Government policies should consider these heterogeneous distributional effects of private health insurance.

Effects of Private Health Insurance on Waiting Time in Public Hospitals

Effects of Private Health Insurance on Waiting Time in Public Hospitals

Private Health Insurance and Financial Risk Taking in Spain—The Moderating Effect of Subjective Risk Tolerance

This study focuses on the effect of private health insurance on financial risk taking in Spanish households. According to the arguments related to the background risk, we propose two hypotheses: the first predicts a positive relationship between health insurance and risk taking and the second asserts that attitude to risk moderates this relationship. Spain is a good laboratory because it has a National Health System (NHS) that offers healthcare coverage to the entire population, which could eliminate the effect of health insurance on risk taking. Based on a sample of 6110 households obtained from the Household Finance Survey (EFF), our results confirm both hypotheses. Specifically, we show that private health insurance significantly increases a household's portfolio risk, especially in households with greater risk aversion. The results are concordant with the scarce amount of previous empirical evidence obtained in other contexts and are robust for different subsamples and estimation methods.

The impacts of health insurance on financial strain for people with chronic diseases

BackgroundDue to ongoing expenses for both short-term and long-term needs for health services, people with chronic diseases tend to struggle with financial hardship. Health insurance is employed as a useful tool in aiding people to solve such financial strain. This study aims to examine and compare the impacts of public and private health insurance on solving financial barriers for people with chronic diseases.MethodsThis research obtained an outpatient sample consisted of 1739 individuals and an inpatient sample consisted of 1034 individuals. We employed a Chi-square test and a two-sample T-test to explore differences in financial strain and insurance status between people with chronic diseases and those without. Then we adopted binary logistic regression technique to assess the impacts of different types of health insurance on outpatient and inpatient financial strain for people with chronic diseases.ResultsOur research has five key findings: first, people with chronic diseases were more likely to experience both the outpatient and inpatient financial strain (P < 0.01); second, public health insurance was found to reduce the outpatient financial strain; third, private health insurance was found to positively associate with inpatient financial barriers; fourth, Urban Employment Insurance (UEI) was expected to reduce both the outpatient and inpatient financial barriers, while self-paid private insurance (SPI) was positively associated with inpatient financial barriers; and fifth, income was identified as a positive predictor of having outpatient and inpatient financial strain.ConclusionsPublic health insurance has the potential to reduce the outpatient financial strain for people with chronic diseases. Private health insurance was identified as a positive predictor of inpatient financial strain for people with chronic diseases. Policy should be proposed to promote the capacity of public health insurance and explore the potential effects of private health insurance on solving the inpatient financial barriers faced by people with chronic diseases in China.

Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance

BackgroundAfter achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI).MethodsWe employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity.ResultsFrom 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results.ConclusionsIn the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.

Estimating the causal effects of private health insurance in Brazil: Evidence from a regression kink design.

Despite having free access to the public health system, 25% of the Brazilian population have a private insurance plan, which is subsidized by the government by means of an income tax rebate. This paper explores this rebate to tackle the potential endogeneity between private insurance and the demand for health services, using the fiscal incentive as a source of quasi-experimental variation in insurance prices. We estimate the average effect of private insurance for the marginal individuals at the kink points by means of a nonseparable nonparametric regression model. Our data allow us to disentangle moral hazard from adverse selection effects and the results indicate that private insurance has a positive impact on the use of preventive services, health outcomes, physical exercises, and smoke quiting, and does not impact the use of nonpreventive health services, such as inpatient services and surgeries.

The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review.

Background: We conducted a systematic review on the role of private health insurance to complement the social health insurance system towards achieving universal health coverage in China. This review presents the impacts of private health insurance on expanding coverage, increasing access to healthcare, and financial protection. Methods: A systematic review was conducted by searching peer-reviewed articles published between January 2000 and March 2018 in Web of Science, PubMed, and China Knowledge Resource Integrated Database. The search terms included coverage prevalence, access and financial protection related to private health insurance in China. A total of 31 studies were selected. Results: Coverage prevalence of private health insurance gradually increased but it was unequally distributed across regions and populations. The expansion of social health insurance has enhanced the total aggregate premium of private health insurance but has had a mixed impact on the take-up of private health insurance. Private insurance beneficiaries were found to limit their utilisation of healthcare services and there was no evidence that it ensured financial protection. Conclusion: The role of private health insurance (PHI) in extending universal health coverage in China was limited and therefore should not be overstated.

Associations Between Private Health Insurance and Medical Care Utilization for Musculoskeletal Disorders: Using the Korea Health Panel Survey Data for 2014 to 2015.

In South Korea, people may increase their medical coverage by purchasing private health insurance to augment low coverage provided by the National Health Insurance (NHI). Frequent and excessive use of medical care by those with private health insurance is an issue, especially for musculoskeletal disorders that require excessive care and contribute to moral hazard. In South Korea, since private health insurance is structurally linked to the scope of coverage with public health insurance, this increased use of medical care may adversely affect public health insurance finances. This study aimed to analyze the effects of private health insurance on medical care use for patients with musculoskeletal disorders. We used the Korea Health Panel 2014 to 2015 data that included 5622 participants who used medical care for musculoskeletal disorders in 2015. Two groups were created: those who purchased private health insurance (n = 3588) and those without private insurance (n = 2034). We compared their medical utilization using logistic regression, negative binomial regression, and multiple linear regression to determine the associations of private health insurance with medical care use. Medical expenditures by private health insurance purchasers were higher than those of non-purchasers for outpatient care (P < .001), but no differences were found for inpatient care. Our findings suggest that the expansion of private health insurance further burdened the NHI financially, ultimately increasing the burden of medical expenses for the population. Research should implement demonstration studies with different groups of diseases.

Effects of Private Health Insurance on Unmet Medical Experience in Chronic disease Patients

Abstract Background Chronic patients are called ’long-term disorders,’ as they last for more than a year. They need continuous care, so health care through easily accessible medical institutions such as primary care is needed for them. In South Korea, however, they are mostly managed through secondary medical service systems, such as hospitals that are difficult to access. This causes them to increase their own burden rate, limiting their ongoing management of the chronic disease. However, it is known that Korea’s private health insurance policy affects the use of medical services, their own burden rate and reduces the unmet medical experience. Therefore this study aims to analyze the impact of the Korean chronic disease on private insurance subscription and unmet medical experience. Methods Using the 2014 survey data of the Korea Welfare Panel, the final analysis of the study was 4,243 households with chronic diseases among 6,581 households. The independent variable of this study is whether private health insurance is subscribed or not, and the dependent variable is unmet medical experience due to economic factors. The analysis method used frequency analysis and logistic regression. [Use SPss 22 for analysis] Results 1,417(33.4%) of households subscribed to private insurance. The figure is significantly lower than the country’s reported private health insurance subscription rate (72.6%). Based on the median income of 60 percent of household income, high-income households have lower unmet medical experience than low-income households. In the case of unsubscribed private health insurance among the people with chronic diseases, the unmet medical experience was 1.921 times higher than that of those who signed up. Conclusions: In order to reduce the burden on chronic patients, the government needs to strengthen the primary medical care system.Reinforce connectivity with private insurance through public financial support of national health insurance. Key messages Chronic disease. Private health insurance.

고령소비자의 민영의료보험 가입이 의료서비스 이용과 의료비지출에 미치는 영향

고령소비자의 민영의료보험 가입이 의료서비스 이용과 의료비지출에 미치는 영향

Effect of Private Health Insurance on Medical Expenditure and Unmet Medical Needs: Evidence from South Korea

South Korea is experiencing increases in private health insurance (PHI). The purpose of this study is to examine the role of PHI on medical expenditure and unmet medical needs. This longitudinal study used data from the nationally representative 2011–2014 Korea Health Panel Survey (KHPS). Propensity score matching was performed to control the endogeneity from enrolling in PHI for the sake of healthcare utilization. Fixed-effects panel data analyses were performed to control for time-invariant factors. The final matched sample of 2,390 participants was retained throughout the study period. In this study, about 83.4% of the participants were covered by PHI in 2011 (fixed benefit 70.2%, indemnity 29.8%). Results from the fixed effects analysis with matched panel data showed that the impact of PHI on personal medical expenditure and unmet medical needs was not statistically significant. However, it was found that PHI had a positive and statistically significant influence on out-of-pocket (OOP) expenditure at point of use, including that for non covered services. Particularly, indemnity type insurance plans had a large effect on OOP expenditure. The results show that PHI increased OOP expenditure but failed to decrease unmet medical needs. Additional analyses of the contribution of PHI and exploration of policy alternatives are required.

Intercept Estimation in Nonlinear Sample Selection Models

The intercept in endogenous selection models is of fundamental importance for the evaluation of average treatment effects. While various intercept estimators for additive linear selection models exist, there are currently no estimators for nonlinear selection models. This paper introduces estimators for semiparametric nonlinear selection models, where the joint distribution of the error terms remains unspecified. We consider models where the intercept and slope parameters can be separately identified. If the selection equation satisfies an index restriction, the resulting estimator is based on a least squares criterion function with a nonparametric correction term. This estimator is asymptotically normal at a univariate nonparametric rate, even in cases of irregular identification. In a second step, we relax the index restriction in the selection equation and adopt a nonparametric propensity score specification. We suggest a local nonlinear least squares estimator, which only uses observations close but not too close to the boundary. Such an estimator exhibits a slower convergence rate than the first one, but is robust against mis-specification of the propensity score. The empirical illustration studies the effect of private health insurance on health care utilization using count data. We find that our estimates of this effect differ from those of various parametric models (not) controlling for selection.

Private health insurance and catastrophic health expenditures of households with cancer patients in South Korea

This study examines the effects of private health insurance (PHI) on the incidence of catastrophic health expenditures (CHE) for households with a patient with cancer. This study uses 1-year data from 2013 and households with cancer patients as the unit of research rather than individual household members. The sample thus includes 468 households with members with cancer who also used emergency, outpatient and hospitalisation services. Households with PHI had a lower incidence of CHE for all thresholds than those without did. At the 10% threshold, the incidence became significantly lower, by 0.59 and 0.60 times, respectively, if householders had higher education and income levels. Moreover, the incidence of CHE was higher by 8.71 times if the householders are female, and lower by 0.84 times if the householders did not have a spouse at the 20% threshold. From the analysis of households with cancer patients that hold PHI as the key variable, these households showed a lower incidence of CHE than the others did. PHI provides healthcare payments not secured through national health insurance (NHI) and protects households from health expenditures, thereby complementing NHI to a certain degree.

Effect of having private health insurance on the use of health care services: the case of Spain

BackgroundSeveral stakeholders have undertaken initiatives to propose solutions towards a more sustainable health system and Spain, as an example of a European country affected by austerity measures, is looking for ways to cut healthcare budgets.MethodsThe aim of this paper is to study the effect of private health insurance on health care utilization using the latest micro-data from the European Community Household Panel (ECHP), the Spanish National Health Survey (SNHS) and the European Union Statistics on Income and Living Conditions (EU-SILC). We use matching techniques based on propensity score methods: single match, four matches, bias-adjustment and allowing for heteroskedasticity.ResultsThe results demonstrate that people with a private health insurance, use the public health system less than individuals without double health insurance coverage.ConclusionsOur conclusions are useful when policy makers design public-private partnership policies.

Social health insurance coverage and financial protection among rural-to-urban internal migrants in China: evidence from a nationally representative cross-sectional study

IntroductionMigrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We...

Effect of Private Health Insurance on Medical Care Utilization: Six Year Unbalanced Panel Data Model

Effect of Private Health Insurance on Medical Care Utilization: Six Year Unbalanced Panel Data Model

The Effect of Private Health Insurance on Self-Assessed Health Status and Health Satisfaction in Germany

In Germany, private health insurance covers more innovative and costly treatments than public insurance. Moreover, privately insured individuals are treated preferentially by doctors. In this article, I use subjective health data to examine whether these superior features of private insurance actually transfer into better health. I focus on German adolescents who are still in education to control for selection and account for differences in health-conscious behavior between publicly and privately insured individuals. I find that privately and publicly insured individuals do not differ in health, which contrasts with previous research. Hence, doctors appear to be the sole profiteers of the private insurance system and billions of euros could be saved by aligning private and public health insurance.