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

Cantarero, David; Pascual-Sáez, Marta; González-Prieto, Noelia

doi:10.1186/s12913-017-2667-4

Cited by 22 publications

(12 citation statements)

References 32 publications

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“…This seems to be the case for the elderly in Italy, Spain, Denmark, and Austria [38]. However, another study in Spain and based on the data from the National Health Survey suggests that people with VPHI "use the public health system less than individuals without double health insurance coverage" [39]. Our study shows that in Spain, the richest population (the fourth and especially the fifth income quintile) have a very high prevalence of VPHI.…”

Section: Discussionmentioning

confidence: 42%

Income and wealth as determinants of voluntary private health insurance: empirical evidence in Spain, 2008–2014

Pinilla

López-Valcarcel

2020

BMC Public Health

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Background: Few 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. Methods: In 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. Results: Cross-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. Conclusion: Our 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.

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Section: Discussionmentioning

confidence: 42%

Income and wealth as determinants of voluntary private health insurance: empirical evidence in Spain, 2008–2014

Pinilla

López-Valcarcel

2020

BMC Public Health

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“…In stark contrast with other European countries that present a consistent share of population with mixed profile of health care coverage (e.g. in Spain 12.45% of the population had mixed health care coverage in 2011–12 [ 30 ]), the intermediate private health care coverage (i.e. private insurances) proportion in Italy is very low (2% in 2016).…”

Section: Methodsmentioning

confidence: 86%

Real and predicted mortality under health spending constraints in Italy: a time trend analysis through artificial neural networks

Golinelli

Bucci

Toscano³

et al. 2018

BMC Health Serv Res

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BackgroundAfter 2008 global economic crisis, Italian governments progressively reduced public healthcare financing. Describing the time trend of health outcomes and health expenditure may be helpful for policy makers during the resources’ allocation decision making process. The aim of this paper is to analyze the trend of mortality and health spending in Italy and to investigate their correlation in consideration of the funding constraints experienced by the Italian national health system (SSN).MethodsWe conducted a 20-year time-series study. Secondary data has been extracted from a national, institution based and publicly accessible retrospective database periodically released by the Italian Institute of Statistics. Age standardized all-cause mortality rate (MR) and health spending (Directly Provided Services - DPS, Agreed-Upon Services - TAUS, and private expenditure) were reviewed. Time trend analysis (1995–2014) through OLS and Multilayer Feed-forward Neural Networks (MFNN) models to forecast mortality and spending trend was performed. The association between healthcare expenditure and MR was analyzed through a fixed effect regression model. We then repeated MFNN time trend forecasting analyses on mortality by adding the spending item resulted significantly related with MR in the fixed effect analyses.ResultsDPS and TAUS decreased since 2011. There was a mismatch in mortality rates between real and predicted values. DPS resulted significantly associated to mortality (p < 0.05). In repeated mortality forecasting analysis, predicted MR was found to be lower when considering the pre-constraints health spending trend.ConclusionsBetween 2011 and 2014, Italian public health spending items showed a reduction when compared to prior years. Spending on services directly provided free of charge appears to be the financial driving force of the Italian public health system. The overall mortality was found to be higher than the predicted trend and this scenario may be partially attributable to the healthcare funding constraints experienced by the SSN.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3473-3) contains supplementary material, which is available to authorized users.

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“…The economic question we set out to answer is: "How does participation in health insurance relate to OOP expenditure on health, along different income levels?" Part of the answer can be found in literature (Gnawali et al, 2009;Nguyen et al, 2011;Zimmer, 2011;Roos and Schut, 2012;Cantarero-Prieto et al, 2017;Dong et al, 2018) that examines the effects of health insurance on healthcare utilization. While available literature deals with whether health insurance leads to either positive or negative or no effects at all, we depart from that focus to examine the possible outcomes subject to the income levels of the insured.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

2021

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Background: Achieving universal health coverage is an important objective enshrined in the 2015 global Sustainable Development Goals. However, the rising cost of healthcare remains an obstacle to the attainment of the universal health coverage. Health insurance is considered an option to reduce out-of-pocket (OOP) expenditure on health and medicine. Nevertheless, the relationship between insurance and the OOP along welfare distributions is not well understood. This study investigates the heterogeneous association between health insurance and OOP expenditure on health and medicine, along income, using data from the Kingdom of Saudi Arabia.Methods: This study used data of 8655 individuals drawn from the Saudi Family Health Survey conducted in 2018. The study adopts Tobit models to account for possible corner solution due to individuals with zero expenditure on health. We minimize the confounding effects of non-random selection into the insurance program by estimating the Tobit equations on a sample weighted by inverse propensity scores of insurance participation. In addition, we test whether the health insurance differently relates to OOP on health and medicine amongst people with access to free medical care as opposed to those without this privilege. The study estimates separate models for OOP expenditure on health and on medicines.Results: Health insurance reduces OOP expenditure on health by 2.0% and OOP expenditure on medicine by 2.4% amongst the general population while increasing the OOP expenditure on health by 0.2% and OOP expenditure on medicine by 0.2%, once income of the insured rises. The relationship between the insurance and OOP expenditure is robust only amongst the citizens, a sub-sample that also has access to free public healthcare. Specifically, the insurance reduces OOP expenditure on health by 3.6% and OOP on medicine by 5.2% and increases OOP expenditure on health by 0.4% and OOP expenditure on medicine by 0.5% once income of the insured increases amongst Saudi citizens. In addition, targeting medicines can lead to greater changes in OOP. The relationship between insurance and OOP is stronger for medicine relative to that observed on health expenditure.Conclusion: Our findings suggest that insurance induces different effects along the income spectrum. Hence, policy needs to be aware of the possible welfare distribution impacts of upscaling or downscaling the coverage of insurance amongst the populations, while pursuing universal healthcare coverage.

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

Cited by 22 publications

References 32 publications

Income and wealth as determinants of voluntary private health insurance: empirical evidence in Spain, 2008–2014

Income and wealth as determinants of voluntary private health insurance: empirical evidence in Spain, 2008–2014

Real and predicted mortality under health spending constraints in Italy: a time trend analysis through artificial neural networks

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

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