Voluntary Private Health Insurance Research Articles

Voluntary private health insurance and cancer screening utilisation in Europe.

Cancer is a leading cause of death in Europe and prevention measures, like screening, are therefore becoming increasingly important. Although European countries provide universal health coverage, including cancer screenings, many people also have private health insurance. The aim of this study is to analyse the relationship between Voluntary private health insurance (VPHI) and cancer screening, specifically breast and colorectal cancer screening. Using data from SHARE, the Survey of Health, Ageing and Retirement in Europe, different logistic and multilevel regressions were estimated. The major finding shows a positive correlation between people being screened for cancer and having VPHI. Three conclusions can be drawn: advantageous selection may exist in private health insurance; spillover effects may exist from the public sector into the private sector, which in turn may result in a lower insurance premium; and there may be a perpetuation of inequalities in health service utilisation. Several policy implications can be drawn from this result, but the most relevant concerns narrowing the inequities that could potentially arise between those who have private health insurance and those who do not.

Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia

ObjectivesTo explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems.MethodsA qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines.ResultsWe developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities.ConclusionsThese findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

Voluntary private health insurance and management of frailty in European Health Systems: a longitudinal analysis

Abstract Frailty is a major health concern associated with aging. It is a state of multisystem physiological decline and inability to maintain homeostasis, gradually leading to an increased risk of multiple adverse outcomes, such as falls, hospitalizations, and death. The prevalence of frailty in community-dwelling older Europeans (65 years and older) varies between 5.8% and 27.3%; in addition, between 34.6% and 50.9% are classified as ‘pre-frail’. In the face of the rapid population ageing occurring in Western societies, frailty is set to reach epidemic proportions over the next few decades. Although most European health care system offer essential treatment free of charge, voluntary private health insurances (VPHI) are becoming more common. Their coverage can be complementary or supplementary including access, faster treatment, waiting list avoidance, and out-of-pocket refund. A growing body of evidence is showing that there is erosion of the universal health coverage in European Health Systems and accessing VPHI might impact quality of care, especially for complex conditions i.e. Frailty. Using European data from the 2013 to 2011 we will assess trends of VPHI in individuals 65 years and older and whether accessing VPHI impacts frailty management and quality of life for elderly Europeans who are frail. These findings will help assessing quality of frailty management in European Health Systems and identify possible inequalities in accessing health services.

Private health insurance in the universal public healthcare system: The role of healthcare provision in Finland

Voluntary private health insurance (VPHI) has gained popularity in universal public healthcare systems. We studied how the local provision of healthcare services correlated with VPHI take-up in Finland. Nationwide register data from a Finnish insurance company was aggregated to the local level and augmented with high-quality data on public and private primary care providers’ geographical closeness and fees. We found that the sociodemographic characteristics explained the VPHI take-up more than public or private healthcare provision. The VPHI take-up was negatively associated with distance to the nearest private clinic, while the associations with distance to public health stations were statistically weak. Fees and co-payments for healthcare services were not associated with insurance take-up, meaning that the geographical closeness of providers explained the take-up more than the price of services. On the other hand, we found that VPHI take-up was higher when local employment, income and education levels were higher.

Voluntary private health insurance demand by Portuguese seniors before the COVID-19 pandemic.

The Portuguese health system is mainly described as a National Health Service (NHS), but it also has some Bismarckian features. On top of these two layers of health insurance coverage, there is a market for voluntary private health insurance (VPHI). Usually, seniors are not eligible for this type of health insurance and this may serve as a complement or supplement to the NHS. The purpose of this work is to identify the main factors associated with holding a VPHI policy among seniors before the COVID-19 pandemic. We use data collected by the National Health Survey of 2019/20 and estimate a multivariate logistic regression. The main findings show that VPHI may be bought by seniors as a facilitator to access health care, either specialised or dental care. While oral health is not covered by the NHS, specialist care is only available after referral by a gatekeeper and requires a long waiting time to be scheduled. Results show that people who had an appointment with a dentist or a specialist in the last 12months are more likely to have a VPHI policy. Additionally, it was found that people benefiting from occupation-based insurance schemes are less likely to buy private health insurance. The current Portuguese health system organization based on different layers of health protection raises some issues concerning equity to health care access by seniors.

Price elasticity of demand for voluntary health insurance plans in Colombia

BackgroundSince 1993, Colombia has had a mandatory social health insurance scheme that aims to provide universal health coverage to all citizens. However, some contributory regime participants purchase voluntary private health insurance (VPHI) to access better quality health services (i. e., physicians and hospitals), shorter waiting times, and a more extensive providers’ network. This article aims to estimate the price elasticity of demand for the VPHI market in Colombia.MethodsWe use data from the 2016–2017 consumer expenditure national survey and apply a Heckman selection model to address the selection problem into purchasing private insurance. Using the estimation results to further estimate the price semi-elasticity for VPHI, we then calculate the price elasticity for the households’ health expenditure and acquisition of VHPI.ResultsOur main findings indicate that a 1% VPHI price increase reduces the proportion of households affiliated to a VPHI in the country by about 2.32% to 4.66%, with robust results across sample restrictions. There are relevant differences across age groups, with younger households’ heads being less responsive to VPHI price changes.ConclusionsWe conclude that the VPHI demand in Colombia is noticeably elastic, and therefore tax policy changes can have a significant impact on public health insurance expenditures. The government should estimate the optimal VPHI purchase in order to reduce any welfare loss that the current arrangement might be generating.

ČIMBENICI POTRAŽNJE ZA DOBROVOLJNIM ZDRAVSTVENIM OSIGURANJEM U EUROPSKIM ZEMLJAMA

During the pandemic, health care services have gained in importance. One of the ways used to finance these services is through voluntary private health insurance. Existing studies on the demand for voluntary private health insurance are based predominantly on the micro-economic level. Therefore, the aim of this paper is to analyse the factors of demand at the macro-economic level. The analysis covers economic and demographic factors, the quality of the public health care system, risk aversion and the status of the population’s health. The empirical research is based on the databases of 29 European countries in the period from 2013 to 2017 and on the dynamic panel model. The results of the empirical analysis revealed that income, price, urbanization, health care system quality, risk aversion/education and self-perceived health are important determinants of demand for voluntary private health insurance in European countries.

Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia

This paper contributes to the discussion around ex-post (increased utilisation of health care) and ex-ante (changes in health behaviours) moral hazard in supplemental private health insurance. Applying a range of methodologies to data from the Russian Longitudinal Monitoring Survey—Higher School of Economics we exploit a selection mechanism in the data to compare the impact of workplace provided and individually purchased supplemental health insurance on the utilisation of health care, on a range of health behaviours and on self-assessed health. We find compelling policy-relevant evidence of ex-post moral hazard that confirms a theoretical prediction and empirical regularity found in other settings. In contrast to other empirical findings though, our data reveals evidence of ex-ante moral hazard demonstrated by clear behavioural differences between those with self-funded supplemental health insurance and those for whom the workplace finances the additional insurance. We find no evidence that either form of insurance is related to improved self-assessed health.

Multi-layer health insurance coverage, medical services use and health in a Universal National Health System, the case of Portugal

The Portuguese health system has the peculiar characteristic of being a Beveridge-Bismarck type aiming at universal coverage. On top of the national health system coverage, there is a second coverage provided to some professionals, plus a third layer of coverage that can be acquired by taking out voluntary private health insurance. The aim of this work is to ascertain whether people benefiting from supplemental multi-layer health coverage (on top of the existing National Health System) have more consultations, either with general practitioners or with specialists, and enjoy better health status. We used data from the National Health Survey from 2014 to estimate a recursive system of ordered probits. The main results confirm that multi-layer health coverage is correlated with the use of more specialist consultations, but not with more GP consultations. It is also correlated with better health status. These results may indicate the existence of moral hazard, induced demand and/or 'access effect'. Regarding policy matters, the measures aimed to reduce waiting times, improve patient choice, and increase access could counteract such results and mitigate the potential inequity of access and health status, and also excessive use of medical services that can happen under double health coverage.

Income and wealth as determinants of voluntary private health insurance: empirical evidence in Spain, 2008\u20132014

BackgroundFew studies have quantitatively estimated the income elasticity of demand of voluntary private health insurance (VPHI) in countries with a universal National Health Service. Most studies to date have uses cross-sectional data.MethodsIn this paper we used a longitudinal database from the Bank of Spain to analyse the financial behaviour of approximately six thousand families per wave. We used three waves (2008, 2011 and 2014). We estimated income and wealth semi-elasticities of VPHI in Spain considering personal and family characteristics (age, sex, level of health, education, composition of the household), i.e. changes in the probability of buying VPHI as result of 1% change in income or wealth. We estimated cross-sectional models for each wave and longitudinal models for families remaining for at least two waves, taking account of possible selection bias due to attrition.ResultsCross-sectional models suggest that the income effect on the probability of buying a VPHI increased from 2008 to 2014. The positive impact was observed for, wealth. In 2008 a 1% increase in income is associated with an increase in the probability of having VPHI of 0.064 [95%-CI: 0.023; 0.104] - on the probability scale (0.1) – whereas in 2014, this effect is of 0.116 [95%-CI, 0.094; 0.139]. In 2011 and 2014 the wealth effect is not significant at 5%. The estimation of the longitudinal model leads to different results where both, income and wealth are associated with non- significant results.ConclusionOur three main conclusions are: 1) Cross-sectional estimates of semi-elasticities of VPHI might be biased upwards; 2) Wealth is alongside income are economic determinants, of the decision to buy VPHI in high-income countries; 3) The effects of income and wealth on the probability of buying VHPI are neither linear nor log-linear. There are no significant differences among 60% of the most disadvantaged families, while the families of the two upper wealth quintiles show clearly differentiated behaviour with a higher probability of insurance.

The impact of macro-fiscal factors and private health insurance financing on public health expenditure: evidence from the OECD countries for the period 2000–2017

PurposeBecause of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing.Design/methodology/approachThe authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE.FindingsThe authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and voluntary private health insurance financing present a negative statistically significant impact on our estimated outcome variable. Different specifications and sample periods applied in the regression models reveal how inseparably associated are PHE and OECD's economies compliance on macro-fiscal policies for offsetting public finances derailment.Practical implicationsProviding more evidence on the responsiveness of PHE to several macro-fiscal drivers, it can be a helpful tool for governments to reconsider their persistence on fiscal adjustments measures and rank public health financing to the top of their political agenda. Health systems policies for meeting Universal Health Coverage (UHC) objectives, they should also take into consideration the voluntary PHI institution, especially for economies with insufficient fiscal capacity to raise public health financing.Originality/valueTo the best of knowledge, the impact of unemployment and voluntary PHI funding on public health financing, apart from other macro-fiscal and demographical parameters effect, remains unnoticed in the existing published studies on the topic.

Voluntary private health insurance demand determinants and risk preferences: Evidence from SHARE.

The demand for voluntary private health insurance (VPHI) in universal coverage health systems in Europe raises some questions. The aim of this paper is to determine the factors that explain the decision to purchase VPHI, to analyse the role of individual risk attitudes and self-assessed health (SAH) in purchasing VPHI, to explore the factors that explain individual risk preferences, and to test how SAH relates to those preferences. To achieve this aim, two recursive simultaneous probits are estimated using data collected by SHARE, wave 6. The main results indicate that people who are more satisfied with the health system coverage are more likely to buy VPHI; SAH is negative correlated with VPHI, but being a risk taker contributes to that decision; however, being a risk taker is positively influenced by good health status. This paper contributes to the discussion on the role of SAH and risk preferences in the decision to buy VPHI. It brings new insights for the health insurance companies and for health policy makers. HIGHLIGHTS: People who are more satisfied with the health system coverage are more likely to buy voluntary private health insurance. The longer the planning horizon assumed by individuals, the greater the likelihood they are risk takers. People reporting being risk takers are more likely to have taken out voluntary private health insurance. Self-assessed health influences the decision to buy voluntary private health insurance in two ways: a direct one, where better health lowers the odds of having insurance, and an indirect one through risk taking, which increases the odds of having insurance. Contributions of this work are mainly for health policy makers and insurance companies.

Sex Differences in Factors Affecting Hospital Outpatient Department Visits: Korea Health Panel Survey Data from 2009 to 2016

This study intends to inspect the sex differences in proportion of hospital outpatient department (OPD) visits in overall outpatient (OP) visits using national panel data and to explore factors that influence the proportions by sex. This study analyzed data of the 2009–2016 Korea Health Panel Survey. Fractional logit regression was applied to analyze factors that affect proportion of hospital visits among outpatient visits. Analysis of related factors was carried out first for all analysis subjects and then by sex. The study data were provided by 7470 women (52.2%) and 6846 men (47.8%). The overall average number of OP visits was 13.0, and women showed a much higher frequency of visits (15.8) than men (9.9). The average proportion of hospital OPD visits among overall OP visits was 21.9%, and men showed a higher rate (25.1%) than women (19.5%). The analysis model including sociodemographic factors, economic factors, and health-related factors confirmed that men showed a higher rate of hospital usage than women. Type of medical security, household income, participation in economic activities, disability, and serious illnesses were significant variables for both sexes. Age, education level, marital status, and subscription to voluntary private health insurance were significant only for women, whereas region of residence was significant only for men. This study confirmed that there is a sex difference in proportion of hospital OPD visits and in the factors that affect the proportion of hospital OPD visits. Universal health coverage is provided through social health insurance, but there is a sex difference in hospital OPD visits, and factors related to socioeconomic status have a significant effect, especially on women’s selection of health care institutions. More attention should be given to sex differences in factors affecting health care utilization.

The effect of financial risk on the demand for supplementary health insurance

As access to medical services provided by public healthcare system in Poland is limited, private supplementary health insurance becomes an increasingly interesting option for pa-tients. Private insurance market has grown significantly in recent years. Therefore, it is interesting to determine factors contributing to the demand for supplementary health insurance by adopting a mathematical model of both compulsory public health insurance and additional, voluntary private health insurance. Such a model was introduced in Dudzinski’s work (2015). The model takes into consideration such factors like compulsory insurance premium, health status of a patient and effectiveness of the public health care system. In this paper we extend the model to the case of additional background financial risk. We show that introducing the additional source of risk exerts certain impact on the demand for the supplementary insurance, however its overall effect depends on the pa-tient’s prudence related to a sign of third derivative of the utility function. The paper pro-poses conditions under which the demand for supplementary insurance increases or de-creases, depending on the relation between patient’s prudence with respect to wealth and cross-prudence in health. The results are different from Dudzinski’s article which considered a two-period model.

Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics.

For almost a century, the Netherlands was marked by a large market for voluntary private health insurance alongside state-regulated social health insurance. Throughout this period, private health insurers tried to safeguard their position within an expanding welfare state. From an institutional logics perspective, we analyze how private health insurers tried to reconcile the tension between a competitive insurance market pressuring for selective underwriting and actuarially fair premiums (the insurance logic), and an upcoming welfare state pressuring for universal access and socially fair premiums (the welfare state logic). Based on primary sources and the extant historiography, we distinguish six periods in which the balance between both logics changed significantly. We identify various strategies employed by private insurers to reconcile the competing logics. Some of these were temporarily successful, but required measures that were incompatible with the idea of free entrepreneurship and consumer choice. We conclude that universal access can only be achieved in a competitive individual private health insurance market if this market is effectively regulated and mandatory cross-subsidies are effectively enforced. The Dutch case demonstrates that achieving universal access in a competitive private health insurance market is institutionally complex and requires broad political and societal support.

Development of voluntary private health insurance in Nordic countries – An exploratory study on country-specific contextual factors

The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.

How and why do countries differ in their governance and financing‐related administrative expenditure in health care? An analysis of OECD countries by health care system typology

Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems.

Introducing voluntary private health insurance in a mixed medical economy: are Hong Kong citizens willing to subscribe?

BackgroundStruggling to correct the public-private imbalance in its health care system, the Hong Kong SAR Government seeks to introduce a government-regulated voluntary health insurance scheme, or VHIS, a distinctive financing instrument that combines the characteristics of private insurance with strong government regulation. This study examines citizens’ responses to the new scheme and their willingness to subscribe.MethodsFirst-hand data were collected from a telephone survey that randomly sampled 1793 Hong Kong adults from September 2014 to February 2015. Univariate and multivariate methods were employed in data analysis.ResultsMore than one third of the respondents explicitly stated intention of subscribing to the VHIS, a fairly high figure considering the scheme’s voluntary nature. Multivariate analysis revealed moderate evidence of adverse selection, defined as individuals’ opportunistic behaviors when making insurance purchasing decision based on their own assessment of risks or likelihood of making a claim.ConclusionThe excellent performance of Hong Kong’s public medical system has had two parallel impacts. On the one hand, high-risk residents, particularly the uninsured, do not face a pressing need to switch out of the overloaded public system despite its inadequacies; this, in turn, may reduce the impact of adverse selection that may lead to detrimental effects to the insurance market. On the other hand, high satisfaction reinforces the interests of those who have both the need for better services and the ability to pay for supplementary insurance. Furthermore, the high-risk population demonstrates a moderate interest in the insurance despite the availability of government subsidies. This may offset the intended effect of the reform to some extent.

The development of voluntary private health insurance in the Nordic countries

The Nordic countries represent an institutional setting with tax-based health care financing and universal access to health care services. Very few health care services are excluded from what are offered within the publically financed health care system. User fees are often non-existing or low and capped. Nevertheless, the markets for voluntary private health insurance (VPHI) have been rapidly expanding. In this paper we describe the development of the market for VPHI in the Nordic countries. We outline similarities and differences and provide discussion of the rationale for the existence of different types of VPHI. Data is collected on the population covered by VPHI, type and scope of coverage, suppliers of VPHI and their relations with health providers. It seems that the main roles of VPHI are to cover out-of-pocket payments for services that are only partly financed by the public health care system (complementary), and to provide preferential access to treatments that are also available free of charge within the public health care system, but often with some waiting time (duplicate).Published: April 2016.

La atención primaria en Bélgica

Belgium is an attractive country to work in, not just for doctors but for all Spanish workers, due to it having the headquarters of European Union. The health job allure is double; on the one hand, the opportunity to find a decent job, and on the other, because it is possible to develop their professional abilities with patients of the same nationality in a health system with a different way of working.The Belgium health care system is based on security social models. Health care is financed by the government, social security contributions, and voluntary private health insurance. Primary care in Belgium is very different to that in Spain. Citizens may freely choose their doctor (general practitioner or specialist) increasing the lack of coordination between primary and specialized care. This leads to serious patient safety problems and loss of efficiency within the system. Belgium is a European country with room to improve preventive coverage.General practitioners are self-employed professionals with free choice of setting, and their salary is linked to their professional activity. Ambulatory care is subjected to co-payment, and this fact leads to great inequities on access to care. The statistics say that there is universal coverage but, in 2010, 14% of the population did not seek medical contact due to economic problems. It takes 3 years to become a General Practitioner and continuing medical education is compulsory to be revalidated.In general, Belgian and Spaniards living and working in Belgium are happy with the functioning of the health care system. However, as doctors, we should be aware that it is a health care system in which access is constrained for some people, and preventive coverage could be improved.