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Opt Out Or Top Up? Voluntary Healthcare Insurance And The Public Vs. Private Substitution

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  • D. Fabbri
  • C. Monfardini

Abstract

We investigate whether people enrolled into voluntary health insurance (VHI) substitute public consumption with private (opt out) or just enlarge their private consumption, without reducing reliance upon public provisions (top up). We study the case of Italy, where a mixed insurance system is in place. To this purpose, we specify a joint model for public and private specialist visits counts, and allow for different degrees of endogenous supplementary insurance coverage, looking at the insurance coverage as driven by a trinomial choice process. We disentangle the effect of income and wealth by going through two channels: the direct impact on the demand for healthcare and that due to selection into VHI. We find evidence of opting out: richer and wealthier individuals consume more private services and concomitantly reduce those services publicly provided through selection into for-profit VHI. These results imply that the market for VHI eases the redistribution from high income (doubly insured) individuals to low income (not doubly insured) ones operated by the Italian National Health Service (NHS). Accounting for VHI endogeneity in the joint model of the two counts is crucial to this conclusion.

Suggested Citation

  • D. Fabbri & C. Monfardini, 2011. "Opt Out Or Top Up? Voluntary Healthcare Insurance And The Public Vs. Private Substitution," Health, Econometrics and Data Group (HEDG) Working Papers 11/28, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:11/28
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    Cited by:

    1. Iwona Laskowska, 2015. "Private health insurance and the problem of moral hazard (Prywatne ubezpieczenia zdrowotne a problem pokusy naduzycia)," Problemy Zarzadzania, University of Warsaw, Faculty of Management, vol. 13(53), pages 58-68.
    2. Lavaste, Konsta, 2023. "Private health insurance in the universal public healthcare system: The role of healthcare provision in Finland," Health Policy, Elsevier, vol. 132(C).
    3. Clara Andresciani & Debora Di Gioacchino & Laura Sabani, 2024. "The political economy of the public/private mix in healthcare: assessing the decongestion effect argument," Working Papers - Economics wp2024_23.rdf, Universita' degli Studi di Firenze, Dipartimento di Scienze per l'Economia e l'Impresa.
    4. Geraci Andrea & Fabbri Daniele & Monfardini Chiara, 2018. "Testing Exogeneity of Multinomial Regressors in Count Data Models: Does Two-stage Residual Inclusion Work?," Journal of Econometric Methods, De Gruyter, vol. 7(1), pages 1-19, January.
    5. Del Vecchio, Mario & Fenech, Lorenzo & Prenestini, Anna, 2015. "Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS," Health Policy, Elsevier, vol. 119(3), pages 356-366.
    6. Cheng, Terence Chai, 2014. "Measuring the effects of reducing subsidies for private insurance on public expenditure for health care," Journal of Health Economics, Elsevier, vol. 33(C), pages 159-179.
    7. Denise Doiron & Nathan Kettlewell, 2018. "The Effect of Health Insurance on the Substitution between Public and Private Hospital Care," The Economic Record, The Economic Society of Australia, vol. 94(305), pages 135-154, June.
    8. 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.
    9. Brenna, Elenka & Giammanco, Maria Daniela, 2024. "The use of voluntary health insurance in the access to specialist care: Evidence from the Italian NHS," Socio-Economic Planning Sciences, Elsevier, vol. 93(C).
    10. Chen, Hua & Ding, Yugang & Wang, Xiangnan & Yang, Yifei, 2023. "The effect of public insurance policy on the private insurance market: New evidence from a quasi-experiment in China," Economic Analysis and Policy, Elsevier, vol. 78(C), pages 937-953.

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    More about this item

    Keywords

    Public provision of private goods; health insurance; bivariate count data model; endogenous multinomial treatment; simultaneous equation modeling;
    All these keywords.

    JEL classification:

    • C34 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Truncated and Censored Models; Switching Regression Models
    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • H44 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Goods: Mixed Markets
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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