Private Expenditure on Health and Voluntary Private Health Insurance

In this thesis, we will discuss private expenditure on health and voluntary private health insurance (PHI). The two themes are linked since private expenditure represents the market for PHI. Knowing and understanding private expenditure on health is a prerequisite for PHI to respond to consumer needs and to improve welfare. The following issues will be addressed in this thesis: (i) the reliability of OECD Health Statistics; (ii) supplementary physicians’ fees; (iii) access to new health technologies; (iv) the regulation of PHI markets and (v) the optimal design of PHI productsIn this thesis, several issues relating to private expenditure on health and voluntary private health insurance (PHI) are being discussed. The two themes are closely linked since expenditure covered by PHI is a part of private expenditure on health. The other part is out-of-pocket expenditure on health. In the European Union (EU), private expenditure represents -on average- 21 per cent of total expenditure on health. Three quarters of private expenditure on health is financed out-of-pocket. PHI finances only 5 per cent of total health spending in the EU. Out-of-pocket expenditure on health may negatively affect access to health care. Especially people on low incomes and in poor health are at risk. They may postpone or forgo necessary treatment because they are not able to pay the bill. In this study, we have focused on two issues relating to out-of-pocket expenditure on health: (i) extra payments guaranteeing free choice of provider (supplementary fees) and (ii) extra payments guaranteeing access to new health technology. Voluntary private health insurance (PHI) can reduce the financial risk related to private health spending. In this thesis, two issues relating to PHI have been addressed: (i) regulation of PHI markets and (ii) optimal design of PHI products

Voluntary additional health insurance in the European union: Free market or regulation?

Recent European Court of Justice (ECJ) case law has highlighted apparent inconsistencies in ECJ rulings on the regulation of voluntary additional health insurance. In 2013, the ECJ upheld Belgian regulations limiting the operation of the free market by restricting increases in premium rates of additional health insurance contracts. By contrast, in 2012, an ECJ ruling required Slovenia to repeal such restrictive legislation and not to hinder the operation of the free market. The objective of this article is to feed the discussion on the question whether and under what conditions free-market-driven additional health insurance in the European Union might be acceptable. We conclude that, provided that basic health insurance effectively covers all essential healthcare (essential healthcare services being broadly defined), additional health insurance could be regulated in the same way as all other non-life insurance

Supplementary physicians' fees: a sustainable system?

In Belgium and France, physicians can charge a supplementary fee on top of the tariff set by the mandatory basic health insurance scheme. In both countries, the supplementary fee system is under pressure because of financial sustainability concerns and a lack of added value for the patient. Expenditure on supplementary fees is increasing much faster than total health expenditure. So far, measures taken to curb this trend have not been successful. For certain categories of physicians, supplementary fees represent one-third of total income. For patients, however, the added value of supplementary fees is not that clear. Supplementary fees can buy comfort and access to physicians who refuse to treat patients who are not willing to pay supplementary fees. Perceived quality of care plays an important role in patients’ willingness to pay supplementary fees. Today, there is no evidence that physician