Uptake Of Private Health Insurance Research Articles

Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia.

The vital role of healthcare financing in achieving universal health coverage is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the instrumental variables. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data were handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity (citizenship), being covered by government guarantee letter, government funding and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI.

Uptake and determinants of private health insurance enrollment in a country with heavily subsidised public healthcare: A cross-sectional survey in East Coast Malaysia.

Malaysia's subsidised public healthcare system is heavily reliant on government funding. Increasing the uptake of private health insurance (PHI) would alleviate the financial burden on public healthcare facilities caused by high patient loads. The study aimed to determine the uptake of PHI and its associated factors among the East Coast Malaysian populations. A cross-sectional online survey was conducted between February and June 2021. Proportionate stratified sampling was applied to select 1138 participants, and logistic regression was performed to determine the factors associated with PHI uptake. The proportion of the study samples that purchased PHI was 54.3%. Enrolment of private health insurance was associated with working in the public sector (aOR: 6.06, 95% CI: 2.65, 13.88) and private sector (aOR: 6.27, 95% CI: 2.65, 14.85), being self-employed (aOR: 9.23, 95% CI: (3.59, 23.70), being in the middle 40% household income percentile (aOR: 2.74, 95% CI: 1.95, 3.85) and top 20% household income percentile (aOR: 4.42, 95% CI: 2.87, 6.80), and living in urban areas (aOR: 1.31, 95% CI: 1.01, 1.70). Even in the presence of subsidised public healthcare, the high proportion of PHI uptake reflects a demand for private health insurance. The study suggests that PHI should be promoted among those who are employed or self-employed, the middle- and high-income groups, and urban residents. The findings may be beneficial for the government and insurance companies to improve strategies to enhance PHI uptake among these population.

Does devolution influence the choice and quality of public (vs private) health care?

Government decentralisation also called ‘government devolution’ (GD) can provide an alternative to the ‘build in’ accountability mechanism of markets by influencing both the choice as well as the perceived quality of public versus private health care. To test this hypothesis, this paper exploits the gradual decentralisation of the political stewardship of the Spanish National Health System (NHS) using a difference-in-differences design. We find that GD (abandoning centralised governance) increases the choice and quality of (measured by the preference for, perceptions of, and satisfaction with) public health care (NHS) compared to private health care. Consistently, we also find that the GD reduces the uptake of private health insurance among higher income and education groups. These effects are mainly driven by improvements in health care quality as well as policy innovation and diffusion.

Analysing the impact of private health insurance on inequities in health care utilization: a longitudinal study from China.

Since the early 2000s, Chinese government has sought to encourage the growth of private health insurance (PHI) while simultaneously expanding the breadth of coverage in its social health insurance (SHI) system. This paper examines how the prevalence of PHI has changed during this period and the extent to which PHI contributed to the growth of horizontal and geographical inequities with a focus on healthcare utilization. National data from China Health and Nutrition Survey between 2000 and 2015 were analysed using a multilevel modelling approach. The analysis investigated the impact of SHI membership as related to PHI uptake, PHI enrolees' utilization of health services and out-of-pocket (OOP) expenses. This study found being covered by an SHI scheme reduced the uptake of PHI between 2004 and 2015. Having PHI caused an increase in utilizing outpatient care but did not affect OOP expenses. Coverage prevalence of PHI in a residential community was positively associated with the average level of healthcare utilization. Coverage prevalence of PHI and its effects on healthcare utilization varied geographically. The findings suggest that expanding the role of PHI was not effective without clear support from government policy. Furthermore, the expansion of PHI may cause an increase in horizontal and geographical inequities in healthcare utilization.

Does Devolution Alter the Choice of Public Versus Private Health Care?

Government decentralisation (GD) can provide an alternative to the ‘build in’ accountability mechanism of markets by influencing the choice of and preference for public versus private health care. To test this hypothesis, this paper exploits the gradual decentralisation of the political stewardship of the Spanish National Health System (NHS) to study the effect of GD on the individual choice of public (NHS) and private health care drawing on a difference-in-differences design. We find that ‘turning on’ the decentralization treatment (abandoning centralised governance) increases the preference for public health care (NHS) compared to control regions that did not exhibit any major change in the health care governance in the least a decade. Specifically, we find that GD increases the perceptions of, satisfaction with, and preference for the NHS. Consistently, we also find that the GD reduces the uptake of private health insurance among higher income and education groups. The effects are mainly driven by improvements in health care quality as well as policy innovation and diffusion.

Private versus public? Examining hospital use by a privately insured population in New South Wales, Australia, using data linkage.

Objective To examine hospital use characteristics of a privately insured cohort including hospital setting (public or private), declared insurance status and category of services received during hospital admission. Methods The study population consisted of 14276 people with membership of a private health insurance (PHI) fund in New South Wales, Australia. The final study cohort included 9004 people with at least one hospital admission over a 6-year period from 1 January 2010 to 31 December 2015. PHI claims data were linked with public hospital records from a Local Health District. Hospital utilisation measures include number of admissions and length of stay. Measures were categorised by hospital user group (public only, private only or both), declared insurance status (PHI or public patient), type of service and admission case weight. Results The study finds that despite having PHI, 40% of people receive services exclusively in a public hospital in the 6-year study period. Additionally, only 62% of overnight hospital admissions for the study population are claimed on PHI. There are differences in hospital utilisation for medical- and surgical-related admissions. Seventy percent of people with a medical admission receive services only in public hospitals, but a similar proportion of people (66%) receive services only in private hospitals for surgical admissions. Conclusions People with PHI make considerable use of public hospitals both as a public and a private patient. For this privately insured cohort, public hospitals are more frequently used for medical-related admissions and also for more resource-intensive admissions compared with private hospitals. What is known about the topic? There are multiple government incentives to encourage people to take out PHI policies in Australia. Although PHI is closely associated with private hospital utilisation, people with PHI can still use public hospitals as either a public patient, in which the service is fully government-funded, or as a private patient in which PHI contributes funding towards the cost of hospital admissions. What does this paper add? This study provides the first analysis of hospital utilisation of a privately insured cohort in Australia that reports on the interaction between public and private hospital use and declared insurance status, including utilisation differences based on service type. What are the implications for practitioners? Although there are financial incentives offered by the Australian Government to encourage uptake of PHI, the study findings show that people with PHI still make considerable use of public hospitals both as a public and private patient. Future policy reforms relating to the regulation of PHI in Australia should consider the nuanced differences in the way people with PHI use public and private hospitals to optimise resource allocation.

Is having private health insurance associated with less support for public healthcare? Evidence from the Norwegian NHS

The purpose of this study was to investigate whether increased uptake of private health insurance (PHI) in a traditionally NHS type system is likely to affect support for the public healthcare system. Using the Norwegian healthcare system as our case, and building on a survey among 7500 citizens, with 2688 respondents, we employed multivariate analysis to uncover whether the preferences for public health services are associated with having PHI, controlling for key predictors such as socio-economic background, self-rated health and perceived health service quality, as well as age and gender. The basis for our analysis was the following two propositions related to the role of public healthcare, which the respondents were asked to score on a 5-point Likert scale (1 = “totally disagree”, 5 = “totally agree”): 1) “the responsibility of providing health services should mainly be public”, and 2) “the activity of private commercial actors should be limited”. The regression analyses showed that the willingness to increase the role of commercial private actors is positively associated with having a PHI. However, we found no relationship between holding a PHI and support for public provision of health services when other factors were controlled for.

Private Health Insurance Incentives in Australia: In Search of Cost-Effective Adjustments.

The appropriate structure, scope and cost of government incentives in the private health insurance (PHI) market is a matter of ongoing debate. In order to inform policy decisions we designed a two-stage study to (1) model the uptake of PHI covering hospital treatment in Australia, and (2) identify the costs of various policy scenarios to the government. Using a microsimulation with a cost-benefit component, we modelled the insurance decisions made by individuals who collectively represented the Australian insurance population in the financial year 2014-15. We found that the mean willingness to pay (WTP) for PHI ranged from A$446 to A$1237 per year depending on age and income. Our policy scenarios showed a considerable range of impacts on the government budget (from A$4 billion savings to A$6 billion expense) and PHI uptake (from 3.4 million fewer to 2.5 million more individuals insured), with cost-effectiveness ranging from -A$305 to A$22,624 per additional person insured, relative to the status quo. Based on the scenario results we recommend policy adjustments that either increase the PHI uptake at a small per-person cost to the public budget or substantially reduce government subsidisation of PHI at a relatively small loss in terms of persons insured.

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

Effect of private insurance incentive policy reforms on trends in coronary revascularisation procedures in the private and public health sectors in Western Australia: a cohort study

BackgroundThe Australian federal government introduced private health insurance incentive policy reforms in 2000 that increased the uptake of private health insurance in Australia. There is currently a lack of evidence on the effect of the policy reforms on access to cardiovascular interventions in public and private hospitals in Australia. The aim was to investigate whether the increased private health insurance uptake influenced trends in emergency and elective coronary artery revascularisation procedures (CARPs) for private and public patients.MethodsWe included 34,423 incident CARPs from Western Australia during 1995-2008 in this study. Rates of emergency and elective CARPs were stratified for publicly and privately funded patients. The average annual percent change (AAPC) in trend was calculated before and after 2000 using joinpoint regression.ResultsThe rate of emergency CARPs, which were predominantly percutaneous coronary interventions (PCIs) with stenting, increased throughout the study period for both public and private patients (AAPC=12.9%, 95% CI=5.0,22.0 and 14.1%, 95% CI=9.8,18.6, respectively) with no significant difference in trends before and after policy implementation. The rate of elective PCIs with stenting from 2000 onwards remained relatively stable for public patients (AAPC=−6.0, 95% C= −16.9,6.4), but increased by 4.1% on average annually (95% CI=1.8,6.3) for private patients (pdifference=0.04 between groups). This rate increase for private patients was only seen in people aged over 65 years and people residing in high socioeconomic areas.ConclusionsThe private health insurance incentive policy reforms are a likely contributing factor in the shift in 2000 from public to privately-funded elective PCIs with stenting. These reforms as well as the increasing number of private hospitals may have been successful in increasing the availability of publicly-funded beds since 2000.

The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

BackgroundSocial and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI). This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity.MethodsA representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia) that illustrates the principal forms and roles of PHI. Literature describing each country’s health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity.ResultsIn the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system.ConclusionPHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care.

Factors Influencing the Future of Paediatric Private Practice in Malta

In Malta, the health system is hybrid, with similarities to both UK system and the US system, where the National Health Service is supplemented by private practice. This is widely performed either as a primary job or as a supplement to a government salary. This article reviews unfavourable secular trends in Maltese fertility, births, marriages, separations, single parenthood and loans incurred after marriage, and relates them to (equally unfavourable in terms of private practice) escalating numbers of paediatricians working in private practice. Overall, future prospects appear bleak for private practice in this branch of medicine, with a dwindling patient pool being shared by an ever-increasing number of paediatricians. The only identifiable factor that may mitigate is the potential for more private health insurance uptake. This must be coupled with a movement to improve the perception of a substantial proportion of the public that facilities are poorer in the private health sector than in the NHS service. Since Malta is a developed, EU country, these results may (cautiously) be extrapolated to other, larger developed countries.

Changes in Inequalities of Access to Dental Care in Australia 1977-2005

Information on dental visits, income and demographic variables were drawn from the Australian National Health Survey between 1977 and 2005. Income-related inequality in access to dental care was calculated using the generalised concentration index (G) and decomposition methods were employed to examine associations with socio-demographic and policy-amenable factors. Statistically significant increases in inequality in dental care use were found after 1995. From 0.026 in 1995, G increased to 0.045 in 2005. The associations between increases in inequality and changes in the uptake of private health insurance suggest a contributory role of the introduction of the Commonwealth government's 30 per cent rebate for private health insurance.

Is Western Australia representative of other Australian States and Territories in terms of key socio-demographic and health economic indicators?

To evaluate the extent to which Western Australian (WA) represents the broader Australian population in terms of key socio-demographic and health economic indicators. We compared key demographic, social and health economic indicators across all Australian States and Territories from Australian government publications in the census years 1991-2006. Jurisdictional averages (JAs) were calculated as the mean (+/-s.d.) or median (+/-range). Observed jurisdiction indicators were compared with the JA and ranked according its representativeness of the JA. WA was among the three closest jurisdictions to the national JA for all socio-demographic and health economic indicators examined, with the exception of uptake of private health insurance (ranked 6th) and per-capita health expenditure (ranked 5th). The Northern Territory and Australian Capital Territory were least representative for the majority of indicators. Excluding the proportions of people living in rural or remote areas (0-100%) and of indigenous origin (0.4-28.8%), variations in the indicators across the jurisdictions were relatively small. Population differences between Australia's States were small, whereas Australia's Territories were least representative of the JA. WA was the most representative population of Australia's eight jurisdictions and continues to be in a strong position to contribute to knowledge of the Australian health system that is applicable Australia-wide.

Policymaking without Policy Choice: The Rise of Private Health Insurance in Denmark

AbstractPolicymaking and policy outcomes are not necessarily the result of a carefully designed process but can result from intertwined political and institutional dynamics that are often difficult to predict from the outset. This article examines such a policy process, the dramatic rise in the uptake of private health insurance (PHI) in Denmark. In a comprehensive welfare state, founded on the principle of universalism, its success is puzzling. The explanation suggested here is that the rise in PHI is an example of policymaking without policy choice. The article reviews the intended and unintended effects concerning equality in health care and public finance. It also notes that the introduction of a private alternative to the universal health care system has not weakened the support for the public services.

Anonymous HIV workplace surveys as an advocacy tool for affordable private health insurance in Namibia

BackgroundWith an estimated adult HIV prevalence of 15%, Namibia is in need of innovative health financing strategies that can alleviate the burden on the public sector. Affordable and private health insurances were recently developed in Namibia, and they include coverage for HIV/AIDS. This article reports on the efficacy of HIV workplace surveys as a tool to increase uptake of these insurances by employees in the Namibian formal business sector. In addition, the burden of HIV among this population was examined by sector.MethodsCross-sectional anonymous HIV prevalence surveys were conducted in 24 private companies in Namibia between November 2006 and December 2007. Non-invasive oral fluid-based HIV antibody rapid tests were used. Anonymous test results were provided to the companies in a confidential report and through presentations to their management, during which the advantages of affordable private health insurance and the available insurance products were discussed. Impact assessment was conducted in October 2008, when new health insurance uptake by these companies was evaluated.ResultsOf 8500 targeted employees, 6521 were screened for HIV; mean participation rate was 78.6%. Overall 15.0% (95% CI 14.2-15.9%) of employees tested HIV positive (range 3.0-23.9% across companies). The mining sector had the highest percentage of HIV-positive employees (21.0%); the information technology (IT) sector had the lowest percentage (4.0%). Out of 6205 previously uninsured employees, 61% had enrolled in private health insurance by October 2008. The majority of these new insurances (78%) covered HIV/AIDS only.ConclusionThe proportion of HIV-positive formal sector employees in Namibia is in line with national prevalence estimates and varies widely by employment sector. Following the surveys, there was a considerable increase in private health insurance uptake. This suggests that anonymous HIV workplace surveys can serve as a tool to motivate private companies to provide health insurance to their workforce. Health insurance taken up by those who are able to pay the fees will alleviate the burden on the public sector.

Taking responsibility or averting risk? A socio-cultural approach to risk and trust in private health insurance decisions

The increasing political significance of private health insurance can be located in an altered understanding of the role of individuals and the State in protecting citizens' welfare. In common with other Western societies, contemporary Australia is marked by an expectation that people will fund their own needs and identify and manage their own risks throughout their life course. However, we lack information on how people come to make their decisions. In particular, there is no analysis of why people choose to invest in private health insurance. This paper reports on an exploratory study investigating the motivations for the uptake of private health insurance. Taking a socio-cultural approach, the study indicates that while people's stated reasons for buying health insurance show some surface similarities with the reasoning expected of neo-liberal citizens, a closer reading of the data indicates they do not approach their decisions in a rational or calculative way. They rely less on weighing evidence (e.g. relevant statistics, the provisions of their contract with the insurance provider and their own experiences) than they do on trust in an impersonal system, i.e. they believe people and systems will not harm them in future situations (Gilson 2003).

The relationship between demographic and health-related factors on dental service attendance by older Australians.

To determine factors associated with dental attendance by those of 60 years or older in a population-based sample. Cross-sectional national health survey. The study used data from the Australian 1995 National Health Survey, which consisted of people interviewed by households. A total of 7,544 eligible respondents randomly selected by households from defined statistical areas.Main outcome measures The main outcome investigated in this study was having had a dental visit in the previous 12 months. Age, income, level of social disadvantage, level of education, uptake of private health insurance, smoking, exercise, self assessment of health and having a health concession card all independently influenced the attendance ratios. In combination, after adjusting for all other factors, factors associated with having visited a dentist for males were age, years of schooling, level of social disadvantage, exercise level index, possession of a health concession card and smoking status. Factors associated with having visited for females were age, education, exercise, smoking status and some levels of the interaction between possession of a health concession card and level of social disadvantage. The strong influence of age, education, exercise and smoking status indicated a need to target dental services towards those elderly persons in low attendance groups, which mostly represented disadvantaged groups.

A survey of dental attendance for the over 60s

Objective To determine factors associated with dental attendance by those of 60 years or older in a population-based sample. Design Cross-sectional national health survey. Setting The study used data from the Australian 1995 National Health Survey, which consisted of people interviewed by households. Subjects and methods A total of 7,544 eligible respondents randomly selected by households from defined statistical areas. Main outcome measures The main outcome investigated in this study was having had a dental visit in the previous 12 months. Main results Age, income, level of social disadvantage, level of education, uptake of private health insurance, smoking, exercise, self assessment of health and having a health concession card all independently influenced the attendance ratios. In combination, after adjusting for all other factors, factors associated with having visited a dentist for males were age, years of schooling, level of social disadvantage, exercise level index, possession of a health concession card and smoking status. Factors associated with having visited for females were age, education, exercise, smoking status and some levels of the interaction between possession of a health concession card and level of social disadvantage. Conclusions The strong influence of age, education, exercise and smoking status indicated a need to target dental services towards those elderly persons in low attendance groups, which mostly represented disadvantaged groups.

Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list?

It was anticipated that increase uptake of Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The best measure of changed demand is the comparison of the actual cases added to that projected given previous trends in PHI uptake. Detailed Victorian data is available up to 2000-1. The total waiting list has varied little, reflecting significant decreases in both in patients added to and removed. There was a marked increase in private sector elective surgery cases coinciding with the fall in additions to the public sector waiting list and in public sector elective surgical cases. The June 2001 Victorian surgical waiting list would have been 69,599 not 41,838 if the PHI uptake rate had continued to fall in line with pre-1999 trends, and that of June 2002 about 100,000 compared to 40,458 in March 2002. Limited data from other states suggests the Victorian trends are representative of all Australia.