Supplemental health insurance and equality of access in Belgium

• Published in: Health economics 2010-04, Vol.19 (4), p.377-395
• Main Authors: Schokkaert, Erik, Van Ourti, Tom, De Graeve, Diana, Lecluyse, Ann, Van de Voorde, Carine
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; adverse selection; Aged; Aged, 80 and over; Algorithms; Belgium; Coverage; Economic models; Equality; equality of access; Female; Health care access; Health economics; Health insurance; Health Services - utilization; Health Services Accessibility; Health Surveys; Healthcare Disparities; healthcare use; hospital spells; Hospitals; Humans; Impact analysis; Insurance Coverage - organization & administration; Insurance, Health; Male; Middle Aged; moral hazard; Private Sector; Socioeconomic factors; State Medicine; Studies; supplemental insurance; Young Adult
• ISSN: 1057-9230; 1099-1050
• DOI: 10.1002/hec.1478

The effects of supplemental health insurance on health‐care consumption crucially depend on specific institutional features of the health‐care system. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra‐billing in hospitals. Within this institutional background, we find only weak evidence of adverse selection in the coverage of supplemental health insurance. We find much stronger effects of socio‐economic background. We estimate a bivariate probit model and cannot reject the assumption of exogeneity of insurance availability for the explanation of health‐care use. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights per spell. We comment on the implications of our findings for equality of access to health care in Belgium. Copyright © 2009 John Wiley & Sons, Ltd.