Supplemental health insurance and equality of access in Belgium

Schokkaert, Erik; Ourti, Tom Van; Graeve, Diana De; Lecluyse, Ann; Voorde, Carine Van de

doi:10.1002/hec.1478

Cited by 31 publications

(20 citation statements)

References 33 publications

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“…Cline, Mott study of demand for supplementary drug plans in elderly Medicare members showed that increased elderly drug expenditures over the previous 30 months and increased drug used by them in this period increased their likelihood of membership in supplementary drug plans ( Cline & Mott, 2003 ). The positive effect of medical expenses on increasing demand for medical insurance is in line with previous studies ( Alegria et al, 2006 ; Schokkaert, Van Ourti, De Graeve, Lecluyse & Van de Voorde, 2010 ; Yellaiah & Ramakrishna, 2012 ).…”

Section: Discussionsupporting

confidence: 90%

Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

Motlagh¹,

Gorji²,

Mahdavi³

et al. 2015

GJHS

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Introduction:In the majority of developing countries, the volume of medical insurance services, provided by social insurance organizations is inadequate. Thus, supplementary medical insurance is proposed as a means to address inadequacy of medical insurance. Accordingly, in this article, we attempted to provide the context for expansion of this important branch of insurance through identification of essential factors affecting demand for supplementary medical insurance.Method:In this study, two methods were used to identify essential factors affecting choice of supplementary medical insurance including Classification and Regression Trees (CART) and Bayesian logit. To this end, Excel® software was used to refine data and R® software for estimation. The present study was conducted during 2012, covering all provinces in Iran. Sample size included 18,541 urban households, selected by Statistical Center of Iran using 3-stage cluster sampling approach. In this study, all data required were collected from the Statistical Center of Iran.Results:In 2012, an overall 8.04% of the Iranian population benefited from supplementary medical insurance. Demand for supplementary insurance is a concave function of age of the household head, and peaks in middle-age when savings and income are highest. The present study results showed greater likelihood of demand for supplementary medical insurance in households with better economic status, higher educated heads, female heads, and smaller households with greater expected medical expenses, and household income is the most important factor affecting demand for supplementary medical insurance.Conclusion:Since demand for supplementary medical insurance is hugely influenced by households’ economic status, policy-makers in the health sector should devise measures to improve households’ economic or financial access to supplementary insurance services, by identifying households in the lower economic deciles, and increasing their financial ability to pay. Moreover, insurance companies should adjust their insurance policy according to clients’ needs, household characteristics, and their incomes.

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Section: Discussionsupporting

confidence: 90%

Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

Motlagh¹,

Gorji²,

Mahdavi³

et al. 2015

GJHS

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“…There is significant evidence that the decision to purchase a VPHI policy is mostly determined by socio-economic variables such as income, wealth, education, social class and employment status (e.g. Cameron et al, 1988;Wolfe and Goddeeris, 1991;Hurd and McGarry, 1997;Vera-Hernandez, 1999;van Doorslaer et al, 2004;Jones et al, 2006;Dormont et al, 2007;Doiron et al, 2008;Dardanoni and Li Donni, 2009;Schokkaert et al, 2010;Bolin et al, 2010) and by cognitive ability (Fang et al, 2008), whereas a clear relationship between observable health measures and the probability to hold or purchase private supplemental insurance is not found, probably because the empirical literature does not provide consistent evidence of the role of adverse selection and because of cream skimming by private insurers. Recently, Bolin et al (2010) revisit these arguments and observe a negative correlation between risk (measured by selfassessed health) and insurance but find no evidence of heterogeneous risk preferences as an explanation of this finding.…”

Section: Review Of Literaturementioning

confidence: 99%

“…In France, more than 80% of insured households are covered for the reimbursement of co-payments (for outpatient and inpatient care, and for drugs), of dental care and of optical prostheses, confirming that VPHI predominantly complements public coverage. In Belgium, VPHI mostly covers full costs of hospital care (75.6% of insured households) and an extended choice of hospitals (40% of insured households), and therefore, it seems predominantly supplementary of public coverage (Schokkaert et al, 2010).…”

Section: Datamentioning

confidence: 99%

VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE

2012

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Using data from SHARE (Survey of Health, Ageing and Retirement in Europe), we investigate the determinants of voluntary private health insurance (VPHI) among the over fifties in eleven European countries, and their effects on health care spending. Firstly, we find that the main determinants of VPHI are different in each country, reflecting differences in the underlying health care systems, but in most countries education levels and cognitive abilities have a strong positive effect on holding a VPHI policy. We also analyse the effect of holding a voluntary additional health insurance policy on out-of-pocket (OOP) health care spending. We adopt a simultaneous-equations approach to control for self-selection into VPHI policy holding and find that only in the Netherlands VPHI policyholders have lower OOP spending than the rest of the population while in some countries (Italy, Spain, Denmark and Austria) they spend significantly more. This could be due to increased utilisation but also to cost-sharing measures adopted by the insurers in order both to counter the effects of moral hazard and to keep adverse selection under control.

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“…At the system-level there are also differences between different types of voluntary private insurance. We can distinguish between three main types: duplicate, supplementary, and complementary coverage [ 21 – 23 ]. The duplicate system covers services already included in the mandatory health insurance.…”

Section: Methodsmentioning

confidence: 99%

Associations of lack of voluntary private insurance and out-of-pocket expenditures with health inequalities. Evidence from an international longitudinal survey in countries with universal health coverage

et al. 2018

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ObjectivesIn countries with universal health coverage (UHC), national public health insurances cover 70% of health expenditures on average, but health care user fees and out-of-pocket expenditures have been neglected in empirical patient-centered health inequality research. This study is the first to investigate how health care-related factors are associated with health status among middle-aged and elderly people—vulnerable groups for the burden of illness—in countries with UHC.DesignLongitudinal observational cohort study.SettingPopulation-based cohort Survey of Health, Ageing and Retirement in Europe (SHARE) in twelve countries with UHC.ParticipantsNon-institutionalized people aged 50 and older (n = 29,260). Two subsamples were also used: participants without global activity limitation at baseline (n = 16,879) and participants without depression at baseline (n = 21,178).Main outcome measuresRisk of death, risk of global activity limitations, and risk of depression. We used mixed-effects Cox proportional hazards regressions to estimate hazard ratios (HR) for all-cause mortality, physical limitations, and depression.ResultsHaving a voluntary private insurance to cover health expenses not included in the public health care system (44.1% of the total sample) was a protective factor for all outcomes (HR≤0.91), controlling for a large range of socio-economic variables. On the contrary, having out-of-pocket expenditures (62.4%) was a risk factor (HR≥1.12).ConclusionsUHC systems are not free from health inequalities: there is a potential effect of lack of voluntary private insurance and out-of-pocket expenditures on mortality and health. Health care-related factors should be at focus in future researches designed to understand and address health inequalities. Reducing out-of-pocket expenditures and developing voluntary private insurance may protect against premature illness and death.

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Supplemental health insurance and equality of access in Belgium

Cited by 31 publications

References 33 publications

Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE

Associations of lack of voluntary private insurance and out-of-pocket expenditures with health inequalities. Evidence from an international longitudinal survey in countries with universal health coverage

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