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.

Income‐related inequality in health and health care in the European Union

“…Moreover, they draw attention to the fact that this phenomenon appears more widespread in the EU, irrespective of the type of private insurance options (supplementary/ complementary) offered: income-related differences in the mix of services generally tend to be exacerbated by private insurance. However, this assertion is not entirely consistent with the findings of Buchmueller et al [18] who examine the impact of the 'supplemental' private insurance cover for the public sector co-payments in France on doctor consultation behaviour. While they do find a strong positive effect of such cover on the volume of services used, they cannot discern any impact on the mix of GP versus specialist consultations.…”

Inequity in publicly funded physician care: what is the role of private prescription drug insurance?

“…This effect is best documented for private insurance that covers the cost-sharing provisions of public insurance plans. In both the United States and France, for example, whose public insurance systems require substantial patient cost-sharing, private complementary insurance that covers the cost-sharing provisions increases use of the publicly insured services (Atherly, 2001;Buchmueller et al, 2004). Because such insurance is held disproportionately by middle and high-income individuals, researchers have argued that it contributes to the pro-rich inequity in the use of physician services in France (van Doorslaer, Masseria et al,2004).…”

Community Rating, Entry-Age Rating and Adverse Selection in Private Health Insurance in Australia

“…18 Shmueli (2001). 19 Buchmueller et al (2004). 20 Barrett and Conlon (2003 Under community rating, the relationship between enrollee demographics and premiums can be summarized as follows:…”