IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0204666.html
   My bibliography  Save this article

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

Author

Listed:
  • Stéphanie Baggio
  • Marc Dupuis
  • Hans Wolff
  • Patrick Bodenmann

Abstract

Objectives: In 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. Design: Longitudinal observational cohort study. Setting: Population-based cohort Survey of Health, Ageing and Retirement in Europe (SHARE) in twelve countries with UHC. Participants: Non-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 measures: Risk 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. Results: Having 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). Conclusions: UHC 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.

Suggested Citation

  • Stéphanie Baggio & Marc Dupuis & Hans Wolff & Patrick Bodenmann, 2018. "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 cover," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-13, October.
    • Handle: RePEc:plo:pone00:0204666
    DOI: 10.1371/journal.pone.0204666
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204666
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0204666&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0204666?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Sukanya Chongthawonsatid, 2017. "Inequity of healthcare utilization on mammography examination and Pap smear screening in Thailand: Analysis of a population-based household survey," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-12, March.
    2. Pierre, Aurélie & Jusot, Florence, 2017. "The likely effects of employer-mandated complementary health insurance on health coverage in France," Health Policy, Elsevier, vol. 121(3), pages 321-328.
    3. Omar Paccagnella & Vincenzo Rebba & Guglielmo Weber, 2008. "Voluntary Private Health Care Insurance Among the Over Fifties in Europe: A Comparative Analysis of SHARE Data," "Marco Fanno" Working Papers 0086, Dipartimento di Scienze Economiche "Marco Fanno".
    4. Oecd, 2004. "Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems," Financial Market Trends, OECD Publishing, vol. 2004(2), pages 125-197.
    5. Hussey, P. & Anderson, G. F., 2003. "A comparison of single- and multi-payer health insurance systems and options for reform," Health Policy, Elsevier, vol. 66(3), pages 215-228, December.
    6. Kiil, Astrid, 2012. "What characterises the privately insured in universal health care systems? A review of the empirical evidence," Health Policy, Elsevier, vol. 106(1), pages 60-75.
    7. Carpenter, Anthony & Islam, M. Mofizul & Yen, Laurann & McRae, Ian, 2015. "Affordability of out-of-pocket health care expenses among older Australians," Health Policy, Elsevier, vol. 119(7), pages 907-914.
    8. Francesca Colombo & Nicole Tapay, 2004. "Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems," OECD Health Working Papers 15, OECD Publishing.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Maria Magdalena Bujnowska-Fedak & Łukasz Wysoczański, 2020. "Access to an Electronic Health Record: A Polish National Survey," IJERPH, MDPI, vol. 17(17), pages 1-17, August.
    2. Guangsheng Wan & Zixuan Peng & Yufeng Shi & Peter C. Coyte, 2020. "What Are the Determinants of the Decision to Purchase Private Health Insurance in China?," IJERPH, MDPI, vol. 17(15), pages 1-15, July.
    3. Eun-Mi Baek & Jae-Il Oh & Eun-Jung Kwon, 2021. "The Effect of Additional Private Health Insurance on Mortality in the Context of Universal Public Health Insurance," IJERPH, MDPI, vol. 18(16), pages 1-10, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Marenzi, Anna & Rizzi, Dino & Zanette, Michele, 2021. "Incentives for voluntary health insurance in a national health system: Evidence from Italy," Health Policy, Elsevier, vol. 125(6), pages 685-692.
    2. Denise Doiron & Nathan Kettlewell, 2020. "Family formation and the demand for health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 523-533, April.
    3. Marijana Curak & Dujam Kovac & Klime Poposki, 2021. "The Drivers Of Voluntary Private Health Insurance Demand In European Countries," Economic Thought and Practice, Department of Economics and Business, University of Dubrovnik, vol. 30(2), pages 457-474, december.
    4. Søgaard, Rikke & Pedersen, Morten Saaby & Bech, Mickael, 2013. "To what extent does employer-paid health insurance reduce the use of public hospitals?," Health Policy, Elsevier, vol. 113(1), pages 61-68.
    5. Nemanja Rancic & Mihajlo (Michael) Jakovljevic, 2016. "Long Term Health Spending Alongside Population Aging in N-11 Emerging Nations," Eastern European Business and Economics Journal, Eastern European Business and Economics Studies Centre, vol. 2(1), pages 2-26.
    6. Boone, Jan, 2015. "Basic versus supplementary health insurance: Moral hazard and adverse selection," Journal of Public Economics, Elsevier, vol. 128(C), pages 50-58.
    7. Sebastian Panthöfer, 2016. "Risk Selection under Public Health Insurance with Opt‐Out," Health Economics, John Wiley & Sons, Ltd., vol. 25(9), pages 1163-1181, September.
    8. repec:dau:papers:123456789/10140 is not listed on IDEAS
    9. Reona Hagiwara, 2022. "Welfare Effects of Health Insurance Reform: The Role of Elastic Medical Demand," IMES Discussion Paper Series 22-E-05, Institute for Monetary and Economic Studies, Bank of Japan.
    10. Hsu, Minchung & Lee, Junsang, 2013. "The Provision Of Public Universal Health Insurance: Impacts On Private Insurance, Asset Holdings, And Welfare," Macroeconomic Dynamics, Cambridge University Press, vol. 17(6), pages 1252-1280, September.
    11. Kumpmann, Ingmar, 2009. "Monopolistic Competition and Costs in the Health Care Sector," IWH Discussion Papers 17/2009, Halle Institute for Economic Research (IWH).
    12. Pedersen, Kjeld Møller, 2011. "Sickness absence and voluntary employer paid health insurance," DaCHE discussion papers 2011:4, University of Southern Denmark, Dache - Danish Centre for Health Economics.
    13. Shin, Jaeun, 2012. "Private health insurance in South Korea: An international comparison," Health Policy, Elsevier, vol. 108(1), pages 76-85.
    14. Andrea M. Leiter & Engelbert Theurl, 2021. "Determinants of prepaid systems of healthcare financing: a worldwide country-level perspective," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 317-344, September.
    15. Sebastian Gechert, 2010. "Supplementary Private Health Insurance in Selected Countries: Lessons for EU Governments?," CESifo Economic Studies, CESifo Group, vol. 56(3), pages 444-464, September.
    16. Randall Ellis & Elizabeth Savage, 2008. "Run for cover now or later? The impact of premiums, threats and deadlines on private health insurance in Australia," International Journal of Health Economics and Management, Springer, vol. 8(4), pages 257-277, December.
    17. Eriksen, Steffen & Wiese, Rasmus, 2019. "Policy induced increases in private healthcare financing provide short-term relief of total healthcare expenditure growth: Evidence from OECD countries," European Journal of Political Economy, Elsevier, vol. 59(C), pages 71-82.
    18. Kiil, Astrid, 2012. "What characterises the privately insured in universal health care systems? A review of the empirical evidence," Health Policy, Elsevier, vol. 106(1), pages 60-75.
    19. Jonas Pendzialek & Dusan Simic & Stephanie Stock, 2016. "Differences in price elasticities of demand for health insurance: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(1), pages 5-21, January.
    20. Loretti I. Dobrescu, 2015. "To Love or to Pay: Savings and Health Care in Older Age," Journal of Human Resources, University of Wisconsin Press, vol. 50(1), pages 254-299.
    21. Minchung Hsu & Tomoaki Yamada, 2019. "Population Aging, Health Care, and Fiscal Policy Reform: The Challenges for Japan," Scandinavian Journal of Economics, Wiley Blackwell, vol. 121(2), pages 547-577, April.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0204666. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.