Role Of Private Health Insurance Research Articles

Private health insurance in the United States and Sweden: A comparative review.

The United States of America and Sweden both contain a public and private component to their healthcare systems. While both countries spend a similar amount per capita on public healthcare expenditures, the United States spends significantly more in the private healthcare sector. Sweden has a social democratic model of health care, and given its identity as a welfare state, private health insurance providers have a small and nuanced role. This paper was completed after searches were queried for "Sweden," "United States," and variants of the words "insurance," "public," "private," "Medicare," "Medicaid," "public," and "costs." A preliminary search in May 2022, yielded 78 articles, of which 45 were ultimately considered relevant for this review. Inclusion criteria consisted of English language articles, topic relevance, and verification of MEDLINE-indexed journals. These searches were performed in PubMed, Google Scholar, Embase, and Cochrane. Summary findings of these searches are compiled in this review. Sweden guarantees low-cost appropriate care to all citizens with equitable access; however, drawbacks of its system include high financial burden, lack of primary care infrastructure, as well as geographical and socioeconomic inequities. On the other hand, the United States' healthcare system is built around the private sector with public health insurance reserved only for the most vulnerable patient populations. Our goal is to provide an overview, compare the role of private health insurance in both countries, and highlight policies that have had beneficial effects in each nation. Possible solutions to the drawbacks of each nation's health insurance policies could be addressed by additional support to Sweden's vulnerable population by developing a program similar to the US' Medicare Advantage program. Conversely, the United States may benefit from increasing access to public health insurance, especially in instances where families face unemployment.

The Role of Supplementary Insurance in Achieving Universal Health Coverage: A Comprehensive Review.

The gradual movement towards universal health coverage (UHC) is an important issue in many countries. The aim of this study is to identify the role of supplementary health insurance in achieving universal coverage. This comprehensive review study was conducted to identify the role of supplementary health insurance in achieving universal health coverage. 4894 articles were found in the search in databases (Scopus, PubMed, and Web Science), and finally42 articles were selected. Considering the criteria of titles and abstracts, the reviewed articles were assessed, and a thematic analysis approach was used to analyze the collected data. The review showed 52 Sub dimensions in 7 dimensions. Policymakers can draw on international experiences to ensure that private health insurance contributes to achieving universal health coverage by Providing clarity within the national health financing policy framework regarding the role of private health insurance. Enhancing understanding of how supplementary health insurance impacts the performance of the healthcare system. They are improving oversight of private health insurance, regulating financial protection and consumer support, and implementing thorough market surveillance and proper allocation of health subsidies between the private and public sectors. Supplementary insurance holds promise as a complementary tool in achieving universal health coverage. Addressing gaps in primary insurance and providing additional financial protection can contribute to enhanced access, improved quality of care, and reduced financial barriers to healthcare services. However, careful attention must be given to affordability, equity, regulation, and coordination with primary insurance schemes to ensure its effective implementation and prevent unintended consequences.

The Effect of the Private Health Insurances and Health Financing on the Population Health in the European Countries

This empirical study addresses the role of economic and institutional determinants on population health, estimated by life expectancy and accessibility to good quality medical services. Several national health systems are described descriptively and analytically. The practical application considers 30 European countries for which data on all necessary variables are available. The data are provided by international institutions such as the World Bank, Insurance Europe, Global Health Security and national institutions from the sampled countries. The results of the OLS cross-country regressions clearly demonstrate the positive role of health financing and the decentralization of the national health system. Instead, the role of private health insurance remains debatable, as does its complementarity or substitutability in relation to public funding. Based on the main results, recommendations are formulated regarding possible adjustments for an increased efficiency of the medical system and possible future research directions, especially regarding the role of the financing structure and the type of decentralization of the medical services.

Rola prywatnych ubezpieczeń zdrowotnych w budowaniu „srebrnej gospodarki” w Polsce

Polskę w kolejnych dekadach czeka proces gwałtownych przemian demograficznych polegający na wzroście udziału seniorów w populacji. W celu utrzymania wzrostu gospodarczego w nowej sytuacji demograficznej zwraca się uwagę na tzw. srebrną gospodarkę, której znaczenie można rozpatrywać zarówno w wymiarze społecznym, jak i ekonomicznym. Ekonomiczne znaczenie koncepcji „srebrnej gospodarki” polega, między innymi, na wskazaniu korzyści wynikających z wykorzystania potencjału popytowego, jaki reprezentuje starsza populacja. Srebrna gospodarka obejmuje szereg segmentów, w tym ubezpieczenia odnoszące się głównie do form ryzyka właściwych starszemu wiekowi. Do tej szerokiej grupy zaliczyć można również prywatne (komercyjne) ubezpieczenia zdrowotne. Celem niniejszego opracowania jest przybliżenie roli prywatnych ubezpieczeń zdrowotnych w kontekście zjawiska budowania srebrnej gospodarki w Polsce. W artykule postawiono hipotezę: seniorzy w Polsce mogą stać się istotnymi inwestorami na rynku ubezpieczeń zdrowotnych. Analiza sytuacji finansowej seniorów, obciążenie budżetów wysokimi wydatkami na zdrowie, szczególnie na wyroby farmaceutyczne, pozwalają na przyjęcie założenia, że odpowiednio skonstruowana oferta może spotkać się z zainteresowaniem tej grupy społecznej.

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.

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.

PHP178 - ROLE OF SUPPLEMENTARY AND COMPLEMENTARY PRIVATE HEALTH INSURANCE IN SELECTED COUNTRIES

The Egyptian government is planning to extend universal health coverage (UHC) for the whole population. Private health insurance (PHI) can support this initiative, in the form of providing complementary (CompHI) and supplementary health insurance (SuppHI) in addition to the public health insurance scheme. This study aims to give an overview of the possible roles of PHI to support the extension of UHC. Countries having CompHI or SuppHI systems and sharing some characteristics with the Egyptian health care system were selected. A targeted literature review was conducted and results of the review were discussed with experts and stakeholders from the field of health insurance. Portugal, Hungary, Netherlands, Turkey and South Africa provided valuable information with regards to i) types of coverage and benefits, ii) regulatory and financing techniques, iii) types of incentives and iv) direct and indirect regulatory tools to manage the private health insurance market. We found that the scope of SuppHI and CompHI was strongly influenced by the regulatory and policy context of the selected countries. Development of UHC in Egypt should be carried out together with CompHI and SuppHI. The mid-term and long-term policy framework to adjust the role of private health insurance to UHC via political, direct and indirect financial objectives should be determined. Pilot disease and therapeutic areas to provide CompHI and SuppHI should be selected to facilitate alignment on the short run.

Private and public patients in public hospitals in Australia

IntroductionThe nature of the private–public mix in health insurance and in health care is a major issue in most health systems. ObjectiveTo compare the hospitalization characteristics of private and public patients hospitalized in public hospitals. MethodsWe focused on planned, overnight and same-day admissions, discharged during 2004–2005 from the public New South Wales hospitals, and run fixed-effects regressions in order to identify the effect of accommodation status (private/public) on the hospitalization characteristics. ResultsPrivate patients have one third less waiting days than public patients, and they are assigned higher urgency of admission. Length of stay and length of visit are both unrelated to the accommodation status, however, private patients tend to have more hours in ICU and more procedures performed during the hospitalization. In-hospital mortality and the number of transfers (wards) are not affected by the accommodation status. ConclusionsPrivate patients are treated differently than public patients in public hospitals, reinforcing the private health insurance-related inequity in inpatient care identified by others. Two health policy issues emerge from the findings: the role of private health insurance in the Australian socialized medicine system, and in particular, in the public hospitals; and the way public hospitals are reimbursed for private patients.

국내 중고령층의 민간의료보험 가입에 대한 영향 요인

In this study we investigated the factors determining people`s decision on whether to subscribe to private health insurance, on how many private health insurances they subscribe to and the average amount of monthly payment from subscribers of private health insurances. For analysis, logistic regression analysis and multiple linear regression analysis were conducted on the sample of 8,167 people using 2008 Korean Longitudinal Study of Ageing(KLoSA) data. From the analysis, whether to enroll in private health insurance is found to be greatly influenced by population and socioeconomic factors as well as regular exercise, smoking, cognitive function scores, subjective health status, hospitalization, the number of outpatient services, free primary health screenings benefits. We also found that number of private health insurances purchased is affected by age, household income, subjective health status, drinking, free primary health screenings benefits and that the average amount of monthly payment for private health insurances purchased is influenced by age, marriage status, economic activities status, subjective sense of hierarchy, household income, drinking, hospitalization. This study is expected to contribute to show the healthy role of private health insurance so that the desirable direction in expansion of health security policy in Korea can be explored further.

Private health insurance in South Korea: An international comparison

ObjectivesThe goal of this study is to present the historical and policy background of the expansion of private health insurance in South Korea in the context of the National Health Insurance (NHI) system, and to provide empirical evidence on whether the increased role of private health insurance may counterbalance government financing, social security contributions, out-of-pocket payments, and help stabilize total health care spending. MethodsUsing OECD Health Data 2011, we used a fixed effects model estimation. In this model, we allow error terms to be serially correlated over time in order to capture the association of private health insurance financing with three other components of health care financing and total health care spending. ResultsThe descriptive observation of the South Korean health care financing shows that social security contributions are relatively limited in South Korea, implying that high out-of-pocket payments may be alleviated through the enhancement of NHI benefit coverage and an increase in social security contributions. Estimation results confirm that private health insurance financing is unlikely to reduce government spending on health care and social security contributions. We find evidence that out-of-pocket payments may be offset by private health insurance financing, but to a limited degree. Private health insurance financing is found to have a statistically significant positive association with total spending on health care. This indicates that the duplicated coverage effect on service demand may cancel out the potential efficiency gain from market initiatives driven by the active involvement of private health insurance. ConclusionsThis study finds little evidence for the benefit of private insurance initiatives in coping with the fiscal challenges of the South Korean NHI program. Further studies on the managerial interplay among public and private insurers and on behavioral responses of providers and patients to a given structure of private–public financing are warranted to formulate the adequate balance between private health insurance and publicly funded universal coverage.

Private expenditure and the role of private health insurance in Greece: status quo and future trends

The health care system in Greece is financed in almost equal proportions by public and private sources. Private expenditure, consists mostly of out-of-pocket and under-the-table payments. Such payments strongly suggest dissatisfaction with the public system, due to under financing during the last 25 years. This gap has been filled rapidly by the private sector. From this point of view, one might suggest that the flourishing development of private provision may lead in turn to a corresponding growth in private health insurance (PHI). This paper aims to examine the role of PHI in Greece, to identify the factors influencing its development, and to make some suggestions about future policies and trends. In the decade of 1985-1995 PHI show increasing activity, reflecting the intention of some citizens to seek health insurance solutions in the form of supplementary cover in order to ensure faster access, better quality of services, and increased consumer choice. The benefits include programs covering hospital expenses, cash benefits, outpatient care expenses, disability income insurance, as well as limited managed care programs. However, despite recent interest, PHI coverage remains low in Greece compared to other EU countries. Economic, social and cultural factors such as low average household income, high unemployment, obligatory and full coverage by social insurance, lead to reluctance to pay for second-tier insurance. Instead, there is a preference to pay a doctor or hospital directly even in the form of under-the-table payments (which are remarkably high in Greece), when the need arises. There are also factors endogenous to the PHI industry, related to market policies, low organisational capacity, cream skimming, and the absence of insurance products meeting consumer requirements, which explain the relatively low state of development of PHI in Greece.

민간의료보험 활성화에 대한 인식과 그에 영향을 미치는 요인

The purpose of this study was to examine the factors influencing the attitude toward the increasing role of private health insurance(PHI). In the Korea Welfare Panel Data 2007, a sample of 1,675 (adjusted by weight value: 1,607) respondents on an opinion on promoting PHI was used in the study. With independent variables including socio-demographic characteristics, health status, health-related behavior, and opinions on welfare service, ordered-probit model was used to analyze the attitude toward PHI. Negative opinion on the increasing role of PHI were responded by 54.6%(n=877) of the respondents, whereas 22.2%( n=373) were positive and 23.2%( n=357) were neutral. Old people, the better off, those with worse self-assessed health status, and those having an experience of health examination tend to have the positive attitude toward the increasing role of PHI. Women, those with chronic diseases or disorders and those who do not agree that comprehensive welfare benefits reduce work incentive showed negative attitude toward PHI. When comparing the needs for PHI before and after medical utilization, ex-ante need tends to strengthen the tendency to support private health insurance. This study will contribute to the discussion on the optimal mix of public and private health insurance in Korea by a better recognition of attitude toward PHI and health care system.

Managed Care and Private Health Insurance in a Global Context

This article provides an overview of the current role of private health insurance and private care management organizations around the globe. We describe past experiences and challenges associated with the export of U.S.-style managed care. We provide a framework for understanding the potential opportunities within a national health system for expanding managed care approaches and also private health insurance more generally. This article is relevant to both the United States and members of the international community.

Different Countries, Different Needs: The Role of Private Health Insurance in Developing Countries

This article discusses the role of private health insurance (PHI) in developing countries. Three broad regional clusters are identified that share similar characteristics and policy challenges for the effective integration of private insurance into national health care systems: (1) Latin America and Eastern Europe, where there are already developed insurance industries facing important market and policy failures; (2) the Middle East/North Africa region and East Asia, where there is a projected strong growth of PHI that needs to be accompanied by efficient regulation; and finally, (3) South Asia and Sub-Saharan Africa, where PHI will only play a marginal role in the foreseeable future while the scaling up of small-scale, nonprofit insurance schemes appears to be of critical importance. Overall, this survey shows that the role of private insurance varies depending on the economic, social, and institutional settings in a country or region. Private health insurance schemes can be valuable tools to complement existing health-financing options only if they are carefully managed and adapted to local needs and preferences.

Why it is time to review the role of private health insurance in Australia.

The role of private health insurance (PHI) within the Australian health-care system is urgently in need of comprehensive review. Two decades of universal health cover under Medicare have meant a change in the function of PHI, which is not reflected in policies to support PHI nor in the public debate around PHI. There is increasing evidence that the series of policy adjustments introduced to support PHI have served to undermine rather than promote the efficiency and equity of Australia's health care system. While support for PHI has been justified to 'take pressure off the public hospital system' and to facilitate choice of insurer and private provider', and the incentives have indeed increased PHI membership, this increase comes at a high cost relative to benefits achieved. The redirection of hospital admissions from the public to private hospitals is small, with a value considerably less than 25% of the cost of the policies. The Commonwealth share of the health care budget has increased and the relative contribution from private health insurance is lower in 2001-02, despite an increase in PHI membership to nearly 45% of the population, compared with the 30% coverage in 1998. The policies have largely directed subsidies to those on higher incomes who are more likely to take out PHI, and to private insurance companies, private hospitals and medical specialists. Ad hoc policy adjustments need to be replaced by a coherent policy towards PHI, one that recognises the fundamental change in its role and significance in the context of universal health coverage.

Why it is time to review the role of private health insurance in Australia

TO THE EDITOR: Since its introduction on 1 January 1999, the 30% rebate has been the subject of much misleading comment by the opponents of the private health sector. A recent addition to these ranks was published in the first edition for 2004 of Australian Health Review (Segal 2004). There is no real attempt at balance in the article. While Segal argues that the rebate has failed to take the pressure off public hospitals, we are not told, for example, that almost one-in-five extra patients admitted by public hospitals in the three years to 2002-03 were actually private patients! Similarly, the article is littered with generalisations and, in some cases, misleading or completely incorrect statements, such as ?Private hospitals do not offer a complete hospital service . . .? Even a cursory examination of the available national data indicates that private hospitals provide services in all but 7 of the 654 diagnosis-related groups (DRGs) recorded. Private hospitals perform all the remaining 647 DRGs.

Parallel Private Health Insurance in Australia: A Cautionary Tale and Lessons for Canada

Canada’s restrictions on the role of private health insurance for publicly insured physician and hospital services are unique among countries with universal, publicly funded health care systems. Pressure is mounting in Canada, however, to loosen these restrictions and create a parallel system of private finance. Advocates argue that creation of a parallel system of private finance will ensure the sustainability of the public system (by reducing public cost pressures), improve access to the public system (e.g., by reducing wait times), and improve quality in the public system (through competition). Opponents of parallel private finance argue that it will create “two-tiered” medicine, increase costs, compromise equity and reduce quality and access to publicly financed health care as those with the financial means (and often the strongest voice) exit to private insurance. Australia provides a particularly promising case study for Canada regarding the dynamics of parallel systems of public and private finance. This paper examines Australia's experience with parallel finance for inpatient hospital services to provide insight regarding: (a) the effectiveness of a parallel system of private finance in reducing costs and wait times in the public system; (b) risk selection between the parallel public and private insurance sectors; (c) the financial redistribution associated with the introduction and maintenance of a parallel system of finance; and (d) the dynamics of the broader political economy associated with parallel systems of finance. Australia's experience provides a number of lessons for Canada, including: (1) the potential for cost savings through introduction or expansion of a parallel private sector is very limited; (2) the introduction or expansion of a parallel private finance is unlikely to reduce wait times in the publicly financed system; (3) there is no simple way to regulate private insurers to pursue public objectives; (4) it is impossible to create an independent, isolated parallel system of private finance is false -- interactions between the public and private insurance sectors are complex and unavoidable; (5) quality plays a key role in driving the dynamics between the public and privately financed sectors; and (6) it is essential to articulate clear policy objectives for health care financing and to design public and private roles consistent with these objectives. Our overall conclusion is that the Australian experience provides a cautionary tale regarding the risks, costs and benefits of a parallel private system of health care finance.

Incremental change in the Australian health care system.

Australia is similar to the United States in that it is a federation of states, its medical profession is well organized and politically powerful, and it has a substantial private sector. Unlike the United States, Australia provides universal access to health care and has controlled its total health care spending to around 8.5 percent of gross domestic product (GDP). This paper reviews the role of private health insurance and recent initiatives to support this; the strategies used to control costs in the fee-for-service sector; and the capacity for experimentation in health care financing within a national system that guarantees universal access.

The Role of Private Health Insurance in Children's Health Care

Private health insurance is the primary means of financing health care for America’s children and pregnant women. Most coverage is provided under employer plans. Access to private health care coverage, however, is threatened by the increasing cost of health care, cost shifting by providers, and insurance marketing practices that tend to deny coverage to high-risk individuals. These pressures have already led to an increase in the number of uninsured children and pregnant women. This paper provides an overview of the private health insurance market with a focus on recent trends. The effects of self-funding arrangements by employers and of various cost-control arrangements—including managed care plans, patient cost-sharing provisions, and employee premium contributions—are examined for their potential impact on children and pregnant women. Policies that might expand health insurance coverage for children, including a universal health insurance plan, and health insurance market reforms, are explored. Alternative strategies for enhancing universal health insurance coverage for children include mandatory employer-based insurance programs, a program of tax credits to underwrite individual insurance plans, and a single-payer government program financed through the tax system. The authors conclude that efforts should be made to preserve the current private health insurance system by reducing cost shifting from public programs, guaranteeing the availability of coverage to all groups, and controlling costs by means of competition, managed care, and perhaps global spending limits. Such comprehensive reforms might be necessary merely to preserve private insurance coverage for a majority of America’s children and pregnant women. P rivate insurance is the primary source of funding for health care for children and pregnant women in the United States. The March 1990 Current Population Survey (CPS) reports that about 63% of all children are covered as dependents under employer health insurance plans and another 10% are covered under individually purchased non-group insurance. About 60% of pregnant women are covered under employer plans, either as employees or as dependent spouses, and about 6% have non-group coverage. The extent of private insurance coverage for children declined during the 1980s largely because of an increase in health care costs, a John F. Sheils, M.P.P., is vice president of Lewin-ICF, a research