Voluntary Private Health Insurance Demand by Older People in a National Health Service, the Case of Portugal

The Portuguese health system is mainly described as a National Health Service (NHS). In parallel with the NHS, there are some Bismarkean features, like those arising from the existence of occupation-based health insurance. On top of these two layers of health insurance coverage, there is a market for private health insurance on a voluntary basis, which older people may not be able to access. The purpose of this work is to estimate the main determinants for older people in Portugal to buy private health insurance since no previous studies have been published. We use data collected by the National Health Survey of 2014 and estimate a multivariate probit. The main results are aligned with previous studies relating to income, education, and age. The role of the health status and behavior explaining the demand for private health insurance, in our results are mixed. People benefiting from parallel occupation-based insurance schemes are less likely to have a private voluntary health insurance policy. The results obtained in this work confirm that there is some inequality in health care access, to the detriment of older people.