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Does voluntary health insurance reduce the use of and the willingness to finance public health care in Sweden?

Published online by Cambridge University Press:  23 March 2021

Linn Kullberg Open the ORCID record for Linn Kullberg [Opens in a new window] ,
Paula Blomqvist  and
Ulrika Winblad Open the ORCID record for Ulrika Winblad [Opens in a new window]
Linn Kullberg*
Affiliation:
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
Paula Blomqvist
Affiliation:
Department of Government, Uppsala University, Uppsala, Sweden
Ulrika Winblad
Affiliation:
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
*
*Corresponding author. Email: linn.kullberg@pubcare.uu.se
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Abstract

Voluntary private health insurance (VHI) has generally been of limited importance in national health service-type health care systems, especially in the Nordic countries. During the last decades however, an increase in VHI uptake has taken place in the region. Critics of this development argue that voluntary health insurance can undermine support for public health care, while proponents contend that increased private funding for health services could relieve strained public health care systems. Using data from Sweden, this study investigates empirically how voluntary health insurance affects the public health care system. The results of the study indicate that the public Swedish health care system is fairly resilient to the impact of voluntary health insurance with regards to support for the tax-based funding. No difference between insurance holders and non-holders was found in willingness to finance public health care through taxes. A slight unburdening effect on public health care use was observed as VHI holders appeared to use public health care to a lesser extent than those without an insurance. However, a majority of the insurance holders continued to use the public health care system, indicating only a modest substitution effect.

Keywords

Health care consumptionhealth care usageprivate health careprivate health insurancewillingness to pay tax
Type
Article
Information
Health Economics, Policy and Law , Volume 17 , Issue 4 , October 2022 , pp. 380 - 397
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Aarbu, K (2010) Demand patterns for treatment insurance in Norway. Department of Economics discussion paper 10, 1–49.Google Scholar
Alexandersen, N, Anell, A, Kaarboe, O, Lehto, JS, Tynkkynen, L-K and Vrangbæk, K (2016) The development of voluntary private health insurance in the Nordic countries. Nordic Journal of Health Economics 4, 68–83.CrossRefGoogle Scholar
Andersson, F, Janlöv, N and Rehnberg, C (2014) Konkurrens, kontrakt och kvalitet - hälso- och sjukvård i privat regi. Rapport till Expertgruppen för studier i offentlig ekonomi och Myndigheten för vårdanalys 2014:5. Ministry of Finance - Government of SwedenGoogle Scholar
Baldini, M and Turati, G (2012) Perceived quality of public services, liquidity constraints, and the demand of private specialist care. Empirical Economics 42, 487–511.CrossRefGoogle Scholar
Besley, T and Coate, S (1991) Public provision of private goods and the redistribution of income. The American Economic Review 81, 979–984. Available at http://www.aeaweb.org/aer/index.php.Google Scholar
Besley, T, Hall, J and Preston, I (1996) Private Health Insurance and the State of the NHS. London: The Institute for Fiscal Studies.Google Scholar
Besley, T, Hall, J and Preston, I (1998) Private and public health insurance in the UK. European Economic Review 42, 491–497. Available at http://www.sciencedirect.com/science/article/pii/S001429219800004X.CrossRefGoogle Scholar
Besley, T, Hall, J and Preston, I (1999) The demand for private health insurance: do waiting lists matter? Journal of Public Economics 72, 155–181.CrossRefGoogle Scholar
Bíró, A and Hellowell, M (2016) Public–private sector interactions and the demand for supplementary health insurance in the United Kingdom. Health Policy 120, 840–847.CrossRefGoogle ScholarPubMed
Blomqvist, P (2020) Chapter Three: Privatisation and Marketisation Within a Healthcare System: The Swedish Experience. In: F, Collyer, K., Willis (eds) Navigating Private and Public Healthcare. Palgrave Macmillan. SingaporeGoogle Scholar
Brekke, KR and Sørgard, L (2007) Public versus private health care in a national health service. Health Economics 16, 579–601.CrossRefGoogle Scholar
Cantarero-Prieto, D, Pascual-Sáez, M and Gonzalez-Prieto, N (2017) Effect of having private health insurance on the use of health care services: the case of Spain. BMC Health Services Research. BioMed Central 17, 716. Available at https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2667-4 [24 April 2019].CrossRefGoogle Scholar
Carder, M and Klingeberg, B (1980) Towards a salaried medical profession: how ‘Swedish’ was the seven crowns reform?. In Heidenheimer, AJ and Elvander, N (eds), The Shaping of the Swedish Health System. London: Croom Helm, pp. 143–172.Google Scholar
Cheng, TC, Kalb, G and Scott, A (2018) Public, private or both? Analyzing factors influencing the labour supply of medical specialists. Canadian Journal of Economics/Revue canadienne d’économique. John Wiley & Sons, Ltd (10.1111) 51, 660–692. doi: 10.1111/caje.12334 [26 April 2019].CrossRefGoogle Scholar
Colombo, F and Tapay, N (2004) Private Health Insurance in OECD Countries the Benefits and Costs for Individuals and Health Systems. OECD Health Working Papers No 15. Paris: OECD Publishing doi: 10.1787/527211067757.Google Scholar
Costa-Font, J (2004) Preference for National Health Service use and the demand for private health insurance in Spain. The Geneva Papers 29, 705–718. Available at http://www.ingentaconnect.com/content/pal/gene/2004/00000029/00000004/art00009.Google Scholar
Costa-font, J and Jofre-bonet, M (2008) Is there a ‘secession of the wealthy’? Private health insurance uptake and national health system support. Bulletin of Economic Research 60, 265–287.CrossRefGoogle Scholar
Costa, J and García, J (2003) Demand for private health insurance: how important is the quality gap? Health Economics 12, 587–599.CrossRefGoogle ScholarPubMed
Doiron, D and Kettlewell, N (2018) The effect of health insurance on the substitution between public and private hospital care. Economic Record 94, 135–154. doi: 10.1111/1475-4932.12394 [26 April 2019].CrossRefGoogle Scholar
Dousa, B (2020) Mer socialism skulle vara förödande f ör sjukvården, Dagens Nyheter: Debatt. Replik, 26 November.Google Scholar
Eldridge, DS, Onur, I and Velamuri, M (2016) The impact of private hospital insurance on the utilization of hospital care in Australia. Available at https://www.tandfonline.com/action/journalInformation?journalCode=raec20 [26 April 2019].Google Scholar
Fabbri, D and Monfardini, C (2016) Opt out or top up? Voluntary health care insurance and the public vs. private substitution. Oxford Bulletin of Economics and Statistics 78, 75–93. doi: 10.1111/obes.12107 [26 April 2019].CrossRefGoogle Scholar
Foubister, T, Thomson, S, Mossialos, E and McGuire, A (2006) Private medical insurance in the United Kingdom. Medical Interface 9, 1–103.Google Scholar
Freeman, R (2000) The Politics of Health in Europe. Manchester and New York: Manchester University Press. Available at https://books.google.se/books?hl=en&lr=&id=dUOgkkTUr2EC&oi=fnd&pg=PR7&dq=Richard+freeman+2000+&ots=HtLgvztC8T&sig=Lb-dsDLjzip1c5EovyCY2lWuFn8&redir_esc=y#v=onepage&q=Richardfreeman2000&f=false.Google Scholar
García-Prado, A and González, P (2007) Policy and regulatory responses to dual practice in the health sector. Health Policy 84, 142–152. Available at https://ac.els-cdn.com/S0168851007000802/1-s2.0-S0168851007000802-main.pdf?_tid=3ef9e320-a38c-11e7-be85-00000aab0f27&acdnat=1506521021_4d0e2ef1b35d080f53ea1dc290687694 [27 September 2017].CrossRefGoogle ScholarPubMed
García-Prado, A and González, P (2011) Whom do physicians work for? An analysis of dual practice in the health sector. Journal of Health Politics, Policy and Law 36, 265–294. Available at http://jhppl.dukejournals.org/lookup/doi/10.1215/03616878-1222721 [28 September 2017].CrossRefGoogle ScholarPubMed
Glenngård, A. H. (2016) The Swedish health care system, 2015. In Mossialos, E, Wenzl, M, Osborn, R and Sarnk, D (eds), 2015 International Profiles of Health Care Systems. Washington, USA: The Commonwealth Fund, pp. 153–160. Available at http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf?la=en.Google Scholar
Gustafsson, A (2019) Svenonius Vill Avskaffa Sig Själv. Stockholm: Dagens Nyheter, 30 November.Google Scholar
Hall, J and Preston, I (1998) Working Paper: Public and Private Choice in UK Health Insurance, No W98/19. London: Institution for Fiscal Studies. DOI: 10.1920/wp.ifs.1998.9819.Google Scholar
Health and Medical Services Act [Hälso- och sjukvårdslag] SFS 2017:30 (n.d.).Google Scholar
Insurance Sweden (2019) Private Health Insurance – statistics. Available at https://www.svenskforsakring.se/statistik/skadeforsakring/sjukvardsforsakring/ [27 May 2019].Google Scholar
Isaksson, D, Blomqvist, P and Winblad, U (2016) Free establishment of primary health care providers: effects on geographical equity. BMC Health Services Research. 16, 28. DOI: 10.1186/s12913-016-1259-zGoogle ScholarPubMed
Jofre-Bonet, M (2000) Public health care and private insurance demand: the waiting time as a link. Health Care Management Science 3, 51–71. Available at https://link.springer.com/content/pdf/10.1023%2FA%3A1019024903898.pdf [22 September 2017].CrossRefGoogle ScholarPubMed
Johannessen, K-A and Hagen, TP (2014) Physicians’ engagement in dual practices and the effects on labor supply in public hospitals: results from a register-based study. BMC Health Services Research 14, 299. Available at https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-299 [29 April 2019].CrossRefGoogle ScholarPubMed
King, D and Mossialos, E (2005) The determinants of private medical insurance prevalence in England, 1997–2000. Health Services Research 40, 195–212.CrossRefGoogle Scholar
Kolada (2020) Public purchase of private healthcare. Available at https://www.kolada.se/verktyg/fri-sokning/?kpis=23801,23821,23841,80809,80864,92997&years=30196,30195,30194&municipals=2328,2329,82304,146551&rows=municipal,kpi&visualization=bar-chart [17 August 2020].Google Scholar
Kullberg, L, Blomqvist, P and Winblad, U (2019) Health insurance for the healthy? Voluntary health insurance in Sweden, Health policy 123(2), 737–746Google Scholar
Lapidus, J (2017) Private health insurance in Sweden: fast-track lanes and the alleged attempts to stop them. Health Policy 121, 442–449. Available at https://www.sciencedirect.com/science/article/pii/S0168851017300325 [24 April 2019].CrossRefGoogle Scholar
Magnussen, J, Vrangbeak, K, Saltman, RB and Martinussen, PE (2009) Introduction: the Nordic model of health care. In Magnussen, J, Vrangbæk, K and Saltman, RB (eds), Nordic Health Care Systems. Maidenhead: Open University Press, pp. 3–20.Google Scholar
Martinussen, P. E. and Magnussen, J. (2019) Is having private health insurance associated with less support for public healthcare? Evidence from the Norwegian NHS. Health Policy 123(7), 675–680. doi: 10.1016/j.healthpol.2019.05.003 [21 May 2019].CrossRefGoogle ScholarPubMed
Moghri, J, Rashidian, A, Arab, M and Akbari Sari, A (2017) Implications of dual practice among health workers: a systematic review. Iranian Journal of Public Health 46, 153–164. Available at http://www.ncbi.nlm.nih.gov/pubmed/28451549 [29 April 2019].Google ScholarPubMed
Morin, A (2016) Privata försäkringar förstärker sjukvården, Svenska Dagbladet.Google Scholar
Mossialos, E and Thomson, S (2002) Voluntary health insurance in the European Union: a critical assessment. International Journal of Health Services 32, 19–88.CrossRefGoogle ScholarPubMed
Mossialos, E and Thomson, S (2004) Voluntary health insurance in the European Union, European Observatory on Health Systems and Policies.Google Scholar
Mou, H (2013) The political economy of the public–private mix in heath expenditure: an empirical review of thirteen OECD countries. Health Policy 113, 270–283. Available at http://linkinghub.elsevier.com/retrieve/pii/S0168851013001930 [22 September 2017].CrossRefGoogle ScholarPubMed
OECD (2004) Private Health Insurance in OECD Countries, The OECD Health Project. Paris: OECD.Google Scholar
OECD (2019), OECDStats 2019, ‘Social Protection – Private Health Insurance’. OECD Available at: https://stats.oecd.org/index.aspx?queryid=30139.Google Scholar
Pihl, K (2019) Vem vill offra sig för systemets sk, Göteborgs-posten, Ledare, 23 December.Google Scholar
Propper, C (2000) The demand for private health care in the UK. Journal of Health Economics 19, 855–876.CrossRefGoogle ScholarPubMed
Propper, C and Green, K (2001) A larger role for the private sector in financing UK health care: the arguments and the evidence. Journal of Social Policy 30, 685–704. Available at https://www.cambridge.org/core/services/aop-cambridge-core/content/view/6642B10F78168FB155AB2138FD4E6517/S0047279401006444a.pdf/larger_role_for_the_private_sector_in_financing_uk_health_care_the_arguments_and_the_evidence.pdf [22 September 2017].CrossRefGoogle Scholar
Roemer, MI (1961) Bed supply and hospital utilization: a natural experiment. Hospitals 35, 36–42.Google ScholarPubMed
Sagan, A and Thomson, S (2016) Voluntary health insurance in Europe: role and regulation.Google Scholar
SAHCSA (2020) Privata sjukvårdsförsäkringar: ett kunskapsunderlag om möjliga konsekvenser för patienter och medborgare.Google Scholar
Saltman, RB, Busse, R and Figueras, J (2004) Social health insurance systems in western Europe European Observatory on Health Systems and Policies Series Social health insurance systems in western Europe.Google Scholar
Sigfrid, K (2019) Sjukvård på lika villkor gör ingen patient gladare, Svenska Dagbladet, Ledare, 20 December.Google Scholar
Søgaard, R, Saaby Pedersen, M and Bech, M (2013) To what extent does employer-paid health insurance reduce the use of public hospitals?. Health Policy 113, 61–68. Available at https://ac.els-cdn.com/S0168851013001620/1-s2.0-S0168851013001620-main.pdf?_tid=89f8fdde-9f90-11e7-b747-00000aacb361&acdnat=1506083060_a46e8611cb3c994b6f56a98d254964c8 [22 September 2017].CrossRefGoogle ScholarPubMed
SOM-institute (2016) Questionnaire 2016, IV. Gothenburg: Göteborgs universitet: SOM-institutet. Available at https://som.gu.se/digitalAssets/1624/1624292_riks-4-2016-v-2.0.pdf.Google Scholar
SOM-institute (2020) The National SOM surveys. Available at https://som.gu.se/som_institute/-surveys/national-som [27 February 2020].Google Scholar
Svallfors, S (2011) A bedrock of support? Trends in welfare state attitudes in Sweden, 1981–2010. Social Policy and Administration 45, 806–825.CrossRefGoogle Scholar
Swedish Ministry of Social Affairs (2020) Begränsning av privata sjukvårdsförsäkringars påverkan på offentligt finansierad hälso- och sjukvård. Stockholm, Sweden: Swedish Ministry of Social Affairs https://www.regeringen.se/rattsliga-dokument/kommittedirektiv/2020/08/dir.-202083/.Google Scholar
Taylor, AJ and Ward, DR (2006) Consumer attributes and the UK market for private medical insurance. International Journal of Bank Marketing 24, 444–460. Available at http://www.emeraldinsight.com/10.1108/02652320610712076.CrossRefGoogle Scholar
Thomson, S and Mossialos, E (2006) Choice of public or private health insurance: learning from the experience of Germany and the Netherlands. Journal of European Social Policy 16, 315–327. Available at http://esp.sagepub.com/cgi/doi/10.1177/0958928706068271 [21 November 2016].CrossRefGoogle Scholar
Tynkkynen, L-K, Alexandersen, N, Kaarbøe, O, Anell, A, Lehto, J and Vrangbæk, K (2018) Development of voluntary private health insurance in Nordic countries – an exploratory study on country-specific contextual factors. Health Policy 122, 485–492.CrossRefGoogle Scholar
Wasem, J, Greβ, S and Okma, KG (2004) The role of private health insurance in social health insurance countries. In Saltman, RB, Busse, R and Figueras, J (eds), World Health Organization - European Observatory on Health Systems and Policies Series: Social Health Insurance Systems in Western Europe European. England: Open University Press, 227–247.Google Scholar
Wendt, C, Kohl, J, Mischke, M and Pfeifer, M (2010) How Do Europeans Perceive Their Healthcare System? Patterns of Satisfaction and Preference for State Involvement in the Field of Healthcareï. European Sociological Review 26(2), 177–192CrossRefGoogle Scholar
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