Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems

DELSA/ELSA/WD/HEA(2004)6 Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems Francesca Colombo and Nicole Tapay 15 OECD HEALTH WORKING PAPERS Unclassified DELSA/ELSA/WD/HEA(2004)6 Organisation de Coopération et de Développement Economiques Organisation for Economic Co-operation and Development ___________________________________________________________________________________________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS COMMITTEE OECD HEALTH WORKING PAPERS NO. 15 PRIVATE HEALTH INSURANCE IN OECD COUNTRIES: THE BENEFITS AND COSTS FOR INDIVIDUALS AND HEALTH SYSTEMS Francesca Colombo and Nicole Tapay Francesca Colombo is with the OECD Health Policy Unit. At the time this work was conducted, Nicole Tapay was with the OECD Financial Markets Division. Document complet disponible sur OLIS dans son format d’origine Complete document available on OLIS in its original format DELSA/ELSA/WD/HEA(2004)6 DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS OECD HEALTH WORKING PAPERS This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France. The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD Applications for permission to reproduce or translate all or part of this material should be made to: Head of Publications Service OECD 2, rue André-Pascal 75775 Paris, CEDEX 16 France Copyright OECD 2004 2 DELSA/ELSA/WD/HEA(2004)6 ACKNOWLEDGEMENTS The authors wish to thank Elizabeth Docteur, Martine Durand, André Laboul, John Martin, Rinaldo Pecchioli and Peter Scherer, for their invaluable comments and suggestions on earlier versions of this paper. Annette Panzera and Rebecca Oyomopito offered statistical assistance. 3 DELSA/ELSA/WD/HEA(2004)6 SUMMARY 1. Governments often look to private health insurance (PHI) as a possible means of addressing some health system challenges. For example, they may consider enhancing its role as an alternative source of health financing and a way to increase system capacity, or promoting it as a tool to further additional health policy goals, such as enhanced individual responsibility. In some countries policy makers regard PHI as a key element of their health coverage systems. 2. While private health insurance represents, on average, only a small share of total health funding across the OECD area, it plays a significant role in health financing in some OECD countries and it covers at least 30% of the population in a third of the OECD members. It also plays a variety of roles, ranging from primary coverage for particular population groups to a supporting role for public systems. 3. This paper assesses evidence on the effects of PHI in different national contexts and draws conclusions about its strengths and weaknesses. Private health insurance presents both opportunities and risks for the attainment of health system performance goals. For example, in countries where PHI plays a prominent role, it can be credited with having injected resources into health systems, added to consumer choice, and helped make the systems more responsive. However, it has also given rise to considerable equity challenges in many cases and has added to health care expenditure (total, and in some cases, public) in most of those same countries. 4. PHI also raises certain challenges that cut across its different roles. Policy-makers will need to intervene to address market failures in order to assure PHI access for high-risk groups. In doing so, they can choose from a range of tools. They need to balance the sometimes competing goals of access and the maintenance of a broad and diverse pool of covered lives, particularly in voluntary markets. 4 ... - tailieumienphi.vn