Health insurance and health services utilization in Ireland

Abstract

The numbers buying private health insurance in Ireland have continued to grow, despite a broadening in entitlement to public care. About 40% of the population now have insurance, although everyone has entitlement to public hospital care. In this paper, we examine in detail the growth in insurance coverage and the factors underlying the demand for insurance. Attitudinal responses reveal the importance of perceptions about waiting times for public care, as well as some concerns about the quality of that care. Individual characteristics, such as education, age, gender, marital status, family composition and income all influence the probability of purchasing private insurance. We also examine the relationship between insurance and utilization of hospital in-patient services. The positive effect of private insurance appears less than that of entitlement to full free health care from the state, although the latter is means-tested, and may partly represent health status.

Private Health Insurance in Ireland

“…This study draws from these data in different sections. Concerning data on insurance coverage, Nolan and Wiley (2000) and Harmon and Nolan (2001) present 1994 data from two waves of the "Living in Ireland Survey" (the Irish European Community Household Panel). Concerning attitudes towards PHI, Nolan and Wiley (2000) and Watson and Williams (2001) analyse data collected from 1999 and 2000 from special modules that were added to the regular data collection on consumers' confidence carried out by the Economic and Social Research Institute for the European Community.…”

“…This suggests that no major difference by health status can be tracked in the privately insured population. Earlier analysis of the determinants of demand for private health insurance indicates that the probability of buying PHI is associated with higher income and educational attainments, with no significant evidence of self-selection by people in poor health (Harmon and Nolan, 2001;Nolan and Wiley, 2000).…”

“…Existing evidence, albeit limited, indicates that people with private cover might receive more intense treatments (Harmon and Nolan, 2001;Nolan and Wiley, 2000). 108 This is consistent with the nature of financial incentives encouraging providers to give privately insured individuals some preferential treatment, particularly the different methods for paying consultants for their public and private practice (salary versus fee-for-service).…”

“…While such differences may be entirely linked to differences in age and health status of these two groups, providers also have incentives to increase volume and intensity of care provided to private patients. Harmon and Nolan (2001) indicate that PHI may increase the probability of hospital stay and the length of time spent in hospital.…”

“…Between 1980 and 1996, premium increases for VHI accumulated to a 438% nominal increase (Harmon and Nolan, 2001). The average premium increase has been higher than the 9.9% 117 average growth of nominal per capita income over the same period.…”