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

Abstract

Aims: 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. Material and Methods: We use data collected by theNational Health Survey of 2019/20 and estimate a multivariate logistic regression. Results: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 12 months 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. Conclusion:The current Portuguese health system organization based on different layers of health protection raises some issues concerning equity to health care access by seniors.

Who is Buying Voluntary Private Health Insurance in Portugal: A Comparative Analysis for 2014 and 2019

“…Demographic and socioeconomic drivers are identical for the two waves of the National Health Survey. As expected, older people are less likely to buy VPHI as found [19,20]. This happens not only as a cream-skimming market strategy by insurance companies but also because primary care contractual goals are favourably biased towards older people [27].…”

“…The oldest study was published in 2003 [17], the author found that some factors associated with buying VPHI such as being older, self-employed, living in urban areas, and receiving high income. Following this study, Tavares [18][19][20] has published some research work on the drivers related to holding VPHI policy in Portugal, focused on the relationship between health insurance demand and lifestyle decisions [18] and on the seniors' segment [19,20]. In this set of empirical work, demographic, socioeconomic, health status, and healthcare utilisation factors were used to explain paying for VPHI.…”

“…This result is expected as health sub-systems function as a second layer of health protection. People benefiting from this level of protection must pay a percentage of their salary, so it is absent the incentive to pay even more for a third layer of protection provided by VPHI [19,20].…”

Impact of the National Health Insurance Program (JKN) on Access to Public Health Services: A Comprehensive Analysis

“…The introduction of JKN marked a pivotal moment in Indonesia's healthcare history (Tavares, 2022). The program's overarching goal is to ensure that every Indonesian citizen and eligible resident has access to quality healthcare services without the risk of financial ruin due to medical expenses to achieve universal health coverage ensuring that every Indonesian citizen and eligible resident has access to essential healthcare services regardless of their socioeconomic status or geographic location.…”