Purchase Private Health Insurance Research Articles

Factors Affecting Intention to Purchase Private Health Insurance: A Study with Reference to Middle Income Group in Thrissur District

There was a paradigm shift in global demand for health insurance during last decade. However, penetration in India is still far behind global average and Kerala, is not an exception. Understanding perception of people and factors driving their intention to purchase hence is of prime importance. With this objective, this study investigates the determinants of health insurance purchase intention among prospective buyers in Thrissur district. The study is based on primary data collected from middle income group private sector employees in urban areas of district who are not yet taken individual health insurance policy. This work focuses on middle income group respondents since there exist potential for expansion of insurance services in this stratum. Empirical analysis done using multiple regression revealed delicate, yet significant relationship between Perceived risk, awareness, cost, and intention to purchase.

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.

Factors affecting the incidence of health insurance penetration among elderly: Evidence from India

A thrust on insurance‐financed health systems may reduce Out‐of‐pocket health spending. But health insurance penetration among Indian elderly is abysmally low. In this context, the paper intends to examine the factors affecting demand for various types of insurances among Indian elderly. Data were drawn from 71st round (2014–15) “Key Consumption: Health” household survey data collected by National Sample Survey Organization (NSSO), Government of India. A total number of 27,245 older adults were selected for this study. In addition to basic descriptive statistics, we employ logistic regression models to conduct the econometric analysis. Socioeconomic, health‐related and contextual predictors are considered in this study. The results show that the probability of health insurance coverage among elderly significantly depends on income, education, disease types, caste, family size, and most importantly, social relationships. The underprivileged groups have higher likelihood to be covered by government‐funded insurance, while the older people with higher income and education, having spouses and less number of children, and residing in urban areas have a higher likelihood of purchasing private health insurance. The study identified the factors responsible for low demand for health insurance among elderly. The study suggests the expansion of private insurance network, especially, in the underserved rural areas, along with generating financial awareness among the elderly. The study also suggests an inclusive model of health insurance demand, which may be adopted by future empirical studies to find out the significant factors affecting health insurance demand.

Ethnicity and Perceived Influence of Social Media-Based Health Information on Health Decisions and Behaviors: A Test of the Social Diversification Hypothesis

The current study examined ethnic differences in the perceived influence of health information found on social media websites on health decisions and behaviors. These differences were examined through the lens of the social diversification hypothesis. The data were collected through a telephone survey. The sample included Israeli adult social media users who reported engaging in health information seeking on social media websites (n = 234). The results of the logistic regression analyses suggest that respondents from the Arab group were more likely than respondents from the Jewish group to report that health information on social media websites has persuaded them to stop or cut down on smoking, undertake medical tests, and purchase private health insurance. In addition, respondents from the Arab group were more likely than respondents from the Jewish group to report being influenced by health information on social media websites in multiple health domains. These findings provide extensive support for the social diversification hypothesis. They point to the need for increased investment in the provision of up-to-date and precise health information to members of disadvantaged population groups in a given society.

The informational content of subjective expectations for health service use

BackgroundThis study aims to evaluate the informational content of people’s subjective probability expectations for using various health services.MethodsUsing a sample of 1,528 Australian adults (25-64 years), I compared stated probabilities of visiting various health service providers (hospitals, dentists, optometrists, physiotherapists and related care providers, naturopaths and massage therapists) with past utilization and with predicted utilization estimated out-of-sample. I also estimated whether past utilization and subjective expectations were predicted by the same covariates. Finally, I estimated whether subjective expectations had predictive power for the choice to purchase private health insurance conditional on past utilization and other controls.ResultsSubjective expectations closely reflect patterns of observed utilization, are predicted by the same covariates as observed utilization, and correlate with objective measures of risk. Subjective expectations also add predictive power to models estimating insurance take-up, even after conditioning on prior health care use and other risk factors.ConclusionThe findings are indicative that on average people form quite accurate expectations, and support collecting subjective expectations about health services in household surveys for use in applied research.

Influence of Successful Aging, Quality of Life, and Factors Related to Potential Stressors on Older Consumers' Purchase of Private Health Insurance in South Korea: An Empirical Study Based on Proactive Coping Theory.

Considering the weak role of public health insurance in South Korea, this study identified the impact of older consumers' coping resources such as income and education, well-being (e. g., successful aging and quality of life), and psychological and economic aspects affecting potential stressors on their purchasing of private health insurance (PHI) based on proactive coping theory. From the sixth wave of the 2016 Korean Longitudinal Study of Aging (KLoSA), a sample of 1,224 Korean older adults aged above 65 years was used; binary logistic regression was conducted to identify the association of PHI and purchase decision factors, first separately for two groups (lower/higher use of health care services), and then for the total group. The results showed that older adults with higher levels of well-being, especially with a higher successful aging index and coping resources such as income are more likely to purchase PHI in all three groups.

Determinants of attitude and intention towards private health insurance: a comparison of insured and uninsured young adults in Australia

BackgroundSince the introduction in 1984 of Australia’s publicly-funded universal healthcare system, Medicare, healthcare financing has relied on a mix of public and private sources to meet the needs of the population (Sowa et al., Appl Health Econ Health Policy 15:31–41, 2018). However, in recent years, there has been a decline in the number of Australians choosing to purchase private health insurance (PHI), particularly within the young adult age group with the proportion of insurance customers aged 20 to 29 falling from 10.3 to 9.4% between 2012 and 2017 (Sivey, The Conversation, 2017). Young adults are critical to private health insurance funding models as their involvement offsets the drawdown by older adults (Dalzell and Borys, ABC News, 2019). While this issue is widely reported in the Australian media, few empirical studies have explored the factors that enable or constrain young adults’ enrolment in PHI.MethodsTo address the scarcity of research about the motivational factors behind young adult decision-making, this study conducted a survey of 594 Australian young adults aged between 18 and 30 years. Within this age group, the survey sought an equal split of participants who were members and non-members of PHI schemes.ConclusionThe findings identified perceived value and trust in insurers as additional motivational factors alongside traditional measures of recognition of the problem and involvement in the problem. Differences between the insured and uninsured groups were identified which help to shape a more holistic understanding of the key motivational factors and barriers in relation to Australian young adults’ enrolment in PHI.

Level of Factors impact on the Buyers’ Intention in Buying Private Health Insurance with the Case of Vietnam Non-Life Insurance Companies

The study aims to determine the influence of factors affecting the intention to purchase private health at non-life companies in Vietnam. The samples were surveyed from 500 people from many areas but mostly in Hanoi. The study identified and clarified 5 independent factors affecting the intention to buy private health at non-life health companies in Vietnam. The analysis results show 5 variables: Past experience, Perception of service quality of companies, Perceived behavioral control, Attitude towards risks and private health , and the variable Subjective norms on private health insurance affect people's intention to buy private health insurance. Several policies have been proposed to increase customers' intention to buy private health at non-life companies from the analysis. To raise customer's intention to purchase private health insurance, the research team recommends non-life company to improve service quality, especially after-sales service, the quality and expertise of staff, and the government to complete policies and legal framework on private health insurance. Moreover, the research team also recommend to renovate the quality of organizing the private health regime and form the basis of the entire population pathology record. Keywords : private health insurance, intention to purchase, non-life company. DOI: 10.7176/EJBM/12-27-06 Publication date: September 30 th 2020

What Are the Determinants of the Decision to Purchase Private Health Insurance in China?

The objective of this study was to assess the determinants of the decision to purchase private health insurance (PHI) in China. Nationally representative data from the fourth wave of the China Household Finance Survey from 2017 were used, and the dataset comprised 105,691 individuals aged 18 years or older. The Andersen health services utilization model was used to inform the research. Chi-square tests and logistic regression analyses were used to estimate the decision to purchase PHI. The proportion of the sample that had PHI was small, at 5.06%, but coverage for social basic medical insurance (SBMI) was 90.64%. Among PHI holders, the overwhelming majority (87.40%) also had SBMI. Logistic regression analysis demonstrated that predisposing factors (age, education, marital status, household size), enabling factors (household income, SBMI status, geographical factors, household medical expense, and medical debt), and needs-based factors (health status) were statistically significant determinants of the decision to purchase PHI. This study suggests that the socio-economic circumstances of households play a crucial role in the decision to acquire PHI. The findings may be used by the insurance industry to inform actions to enhance PHI coverage and by policy decision-makers that seek to improve equality in access to PHI.

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.

Selection bias and moral hazard in the Australian private health insurance market: Evidence from the Queensland skin cancer database

This study estimates the effects of moral hazard and selection bias in private insurance by exploiting the unique characteristics of private health insurance in Australia using a longitudinal data of about 37,000 individuals. We estimate determinants of private health insurance status and health service consumption together as a system to control for individual unobserved effects. We also take into account the evolution of the health production process by controlling for the lagged dependent variables. We found that risk-averse individuals were more likely to purchase private health insurance, suggesting an advantageous selection. There is also evidence of ex-post moral hazard as privately insured individuals consumed more health services. Controlling for the lagged health service consumption reduces the magnitude of moral hazard considerably. The presence of advantageous selection and moral hazard in private health insurance indicates that the Australian healthcare system can be more efficient by increasing coverage and monitoring consumption.

Credit, Default, and Optimal Health Insurance

How do defaults and bankruptcies affect optimal health insurance policy? I answer this question, using a life-cycle model of health investment with an option to default on emergency room (ER) bills and financial debts. I calibrate the model to the U.S. economy and compare the optimal health insurance policies according to whether the option to default is available. I find that the option to default induces the optimal policy to be more redistributive. Without the option to default, the optimal policy expands Medicaid for households whose income is below 30.8 percent of the average income without changing policies related to private health insurance. With the option to default, in addition to Medicaid expansion, the optimal policy offers a progressive subsidy for the purchase of private health insurance to all households whose income is above the threshold of income eligibility for Medicaid and reforms the private health insurance market by improving coverage rates and preventing price discrimination based on pre-existing conditions. This disparity implies that households rely on bankruptcies and defaults on ER bill as implicit health insurance. More redistributive reforms can improve welfare by reducing the dependence on this implicit health insurance and changing households’ medical spending behavior to be more preventative.

PNS78 DIFFERENCES BETWEEN ENROLLEES OF INDIVIDUAL VERSUS SMALL GROUP OFF-EXCHANGE HEALTH PLANS UNDER THE AFFORDABLE CARE ACT

The Patient Protection and Affordable Care Act (ACA) allows individuals and small businesses to purchase private health insurance through competitive marketplaces. Off-exchange plans are ACA compliant, but sold outside the marketplace, and little is known about the characteristics of enrollees of these plans. This analysis examines member severity and annual cost of enrollees of individual versus small group plans. This study used a national sample of claims data for 2.0m individual and 1.7m small group members enrolled in an off-exchange plan in 2017. Cross sectional descriptive analyses were conducted to examine differences between enrollees of individual and small group plans. Individual plan members were much more likely to enroll in a Silver plan (62% versus 36% small group) while small group members were most likely to enroll in a Gold plan (41% versus 7% individual). Average risk scores were higher among individual members by 20% Silver, 27% Gold, and 66% Platinum. Average PMPM costs were also higher in individual members by >2x Platinum, 36% Gold, and 8% Silver. Cost-risk ratios were also higher in individual members by 23% Platinum and 7% Gold, but were 10% lower in the largest group of Silver members. Risk scores were similar among individual and small group Bronze members, but costs were 33% lower in individual enrollees, and mean cost-risk ratios were 23% lower. Overall, the cost-risk ratio was 7% lower in individual plan members compared to those in small group plans. In general, off-exchange members enrolled in individual plans were less costly (relative to risk score) than those enrolled in small group plans. These findings provide insight into the enrollment patterns and relative risk and cost of individual and small group off-exchange enrollees. The results provide new insights into which individual plan members are more likely to be profitable for off-exchange health plans.

Court Rules Individual Mandate, Entire ACA Unconstitutional.

The holiday season brought a potentially fatal blow to the Affordable Care Act, but enrollment remained steady, and the law remains in place.

The Impact of Secondary Environmental Variables on OECD Healthcare Efficiency: A Robust Conditional Approach

Abstract In this paper, I estimate country-level efficiency using a newer order-m estimator where I condition efficiency estimates on secondary environmental variables. This allows me to identify which variables influence the effectiveness of a healthcare delivery system. I find that not controlling for secondary environmental variables leads to the average OECD country being 11% inefficient; after controlling for demographics and economic (social protection) environmental variables, inefficiency reduces to 7% (5%). This provides evidence that a substantial part of the inefficiencies of a healthcare system is related to demographics, socioeconomics, and the structure of the healthcare delivery system. Using the second-stage results, I find lower healthcare spending, both as a percent of GDP and total out-of-pocket, as well as more of the population covered by public health insurance, is related to better efficiency. Lower fertility rates, lower immigration rates, higher incomes, and lower pharmaceutical doses are also consistent with better healthcare efficiency. Lastly, a healthcare system that provides a basic benefits package but allows for purchase of private health insurance, with moderate gatekeeping and flexibility to increase the budget for healthcare through public and private financing, are the most efficient healthcare systems.

A European late starter: lessons from the history of reform in Irish health care.

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

Universal but Precarious: A Case Study of the South Korean Health Care System

Since its inception in 1977, the development of the National Health Insurance system in South Korea took the world by surprise. In 2001, South Korea introduced a single-payment system. However, in spite of the advancements made in medical technology and services and the fact that the National Health Insurance system covers the whole population, its citizens are seemingly still insecure and often experience precariousness with regard to their health coverage. It is ironic that despite the nearly 100% population coverage, many South Koreans also purchase private health insurance because of their anxiety about the limited coverage of the National Health Insurance benefit package. Even though the health care system in South Korea displays symptoms of precariousness, there is still no academic research that analyzes this concept as an approach to understanding the challenges that face the system. In this study, we examine the suitability of applying three attributes of precariousness, namely uncertainty, disempowerment, and insecurity (both financial and institutional), previously researched in the employment sector, to the health system to analyze how South Koreans experienced them and to explain the precariousness of the health care system at both the individual and institutional levels.

Using Behavioral Economics to Understand Premium Tax Credit Reconciliation

The Affordable Care Act provides advanced premium tax credits to millions of Americans to help with the cost of purchasing private health insurance on the new health insurance marketplaces. The amount of subsidy a family qualifies for is based on their projected income for the year ahead. However, since income is fairly unpredictable, some families end up qualifying for a larger tax credit when they do their taxes, while others end up with a smaller credit and must repay what they received throughout the year. In the first year of this reconciliation process, half of those who received advanced premium tax credits had to pay at least a part back. This outcome is consistent with recent literature in behavioral economics, which explores psychological, social, and cognitive influences on decision-making. This paper explores the reconciliation problem and possible approaches to reducing or eliminating it.

Knowledge matters: producing and using knowledge to navigate healthcare systems

ABSTRACTIn many contemporary healthcare systems, individuals are expected to be rational actors – weighing up available knowledge and making choices about their healthcare needs. In the policy context, this has been most explicitly applied to the financing of healthcare where there is encouragement for the purchase of private health insurance. However, perceptions of public and private healthcare provision, knowledge about healthcare needs, and the types of services people choose, are far from straightforward. Drawing on Bourdieu’s concepts of habitus, field, and capital, and a study of individual experiences of choice in Australian healthcare, we explore the knowledges used by people as they navigate through the healthcare system. Such navigation takes place in a milieu where authoritative medical knowledge intersects with knowledge from other sources, including the Internet and lived experience. However, our study reveals that navigation of healthcare is assisted most of all by the capacity to draw on ‘system knowledge’. System knowledge takes two, sometimes overlapping, forms. First, acquired system knowledge is produced through drawing on experience, formal knowledge and the capacity to undertake research (primarily cultural capital). Second, assumed system knowledge enables navigation of the healthcare system through accessing and utilising networks of privilege (primarily economic and social capital).

Unwinding the State subsidisation of private health insurance in Ireland

Ireland's private health insurance market provides primarily supplementary health insurance for hospital services, operating alongside a public hospital system to which residents have universal access entitlements, subject to some copayments for those without a medical card. The State subsidises the purchase of private health insurance through measures including tax relief on premiums and not charging the full economic cost for private beds in public hospitals. Furthermore, privately insured patients occupying public beds in public hospitals did not, until 2014, incur charges for such accommodation, apart from modest statutory charges. In the Budget in October 2013, a number of measures were announced that began to unwind these subsidies. Although it was initially feared that these measures would add to premium inflation, leading in turn to further discontinuation of health insurance, the evidence suggests that premium inflation has eased and take-up has stabilised, although some of this may have been due to the introduction of lifetime community rating in May 2015. Nevertheless, it would appear that the restriction on the subsidisation of private health insurance has not had a significant adverse effect on the market, while it has reduced an inequitable cross-subsidy.