Access to Physician Services: Does Supplemental Insurance Matter? Evidence from France

Abstract

In France, public health insurance is universal but incomplete, with private payments accounting for roughly 25% of all spending. As a result, most people have supplemental private health insurance. We investigate the effects of such insurance on the utilization of physician services using data from the 1998 Enquête sur la santé et la protection sociale, a nationally representative survey of the non‐institutionalized French population. Our results indicate that insurance has a strong and significant effect on the utilization of physician services. Individuals with supplemental coverage have substantially more physician visits than those without. While French patients have greater freedom than patients in other countries to choose to see a specialist rather than a general practitioner, we find no evidence that supplemental insurance affects this decision. Copyright © 2004 John Wiley & Sons, Ltd.

Does employment-based private health insurance increase the use of covered health care services? A matching estimator approach

“…In the larger share of the literature, the potential endogeneity of private health insurance status is taken into account by using various bivariate modelling strategies, including joint estimation of insurance and health care use (Buchmueller et al 2004;Schokkaert et al 2010) and various two-stage estimation procedures (Cameron et al 1988;Coulson et al 1995;Harmon and Nolan 2001;Höfter 2006;Holly et al 1998;Riphahn et al 2003;Savage and Wright 2003;Schellhorn 2001;Vera-Hernández 1999). Jones et al (2006) identified the effect of private health insurance using both joint estimation of insurance status and health care use, and binary probit and matching estimators assuming exogeneity of insurance.…”

“…A number of studies used different socioeconomic characteristics as instrumental variables. Buchmueller et al (2004) excluded an indicator of public sector employment from the utilization equation. This restriction was argued to be theoretically valid given that all public employees are offered private health insurance contracts and most of them take up these contracts, while public sector employment is not expected to impact neither health status nor the use of care.…”

Welfare effects of public health insurance reform: The case of urban China

“…Most empirical studies (Cartwright et al, 1992;Marcos and Vera-Hernandez, 1999;Buchmueller et al, 2004;Ruiz et al, 2007) showed that the male utilizes less medical services than the female. It might be due to the preference difference in health care between the female and male.…”

“…Holly et al (1998), Marcos and Vera-Hernandez (1999), and Buchmueller et al (2004) represent the case study in Switzerland, Spain and France, respectively. They all provide similar results as those studies in the United States mentioned above.…”

Moral hazard or realised access to care?

“…In response to these gaps in the public system, some employers (mostly large corporations), including the government, provide medical benefits to workers and individuals purchase private insurance. The effects of medical benefits and insurance coverage on health care utilisation are interesting and important from both the efficiency and equity perspectives [3]. On efficiency, the principal intended function of co-payments imposed by the public system is to serve as a disincentive for inappropriate or excessive use.…”