BIOETYKA / WPROWADZENIE

BIOETYKA / WPROWADZENIE - Przeglądy aktów prawnych

Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems – OECD 2004

5. Conclusions

142. Private health insurance presents both opportunities and risks for the attainment of health system performance goals. For example, in countries where PHI plays a prominent role, it can be credited with having injected resources into health systems, added to consumer choice, and helped make the systems more responsive. However, it has also given rise to considerable equity challenges in many cases and has added to health care expenditure (total, and in some cases, public) in most of those same countries.

145. As emphasised in this report, the advantages and disadvantages of PHI often depend upon its role within health systems and its interaction with public coverage. Key strengths and weaknesses arising from different PHI roles are:

• A system based on competing primary private insurers can improve responsiveness and consumer choice, but this will come at increased cost. Where private health insurance is primary for certain population groups, ensuring access to affordable coverage will be an important policy consideration. However, regulations to address common primary market failures and promote equity have costs, both in terms of government resources, as well as in terms of diminished insurer flexibility and ability to innovate. Furthermore, it may be particularly challenging to assure adequate access to private coverage for vulnerable populations.

• Duplicate PHI markets can serve as a policy lever to improve systems’ responsiveness when policy makers consider it efficient to ration public health expenditure according to persons’ willingness to pay. Yet, this type of insurance generally results in differences in access to care and coverage according to insurance status. The degree of differential access that occurs, and the extent to which these access variations are perceived to be equity challenges vary by country. In addition, while it can help reduce some of the capacity pressures faced by public health systems, it does not significantly reduce public health expenditure.

• In the presence of significant cost-sharing within public systems, complementary health insurance helps ensure access to needed care. However, full private coverage of public sector cost-sharing encourages moral hazard-induced utilisation. Unless some cost-sharing is retained to maintain individual cost awareness, PHI coverage hinders efforts to control public systems’ outlays.

• Supplementary PHI markets are less intertwined with public coverage systems, in contrast to other PHI roles. Supplemental coverage of services removed, or delisted, from public coverage can reduce public expenditure. However, insurees’ utilisation of supplemental services may still be linked to publicly financed services, resulting in increased public costs as well. Also, since PHI markets generally have less universal reach than public coverage, decisions to de-list services need to balance the desire to reduce public sector cost with the equity implications of no longer covering certain services publicly.

146. PHI also raises certain challenges that cut across its different roles. For example, access to PHI coverage can be an important social objective in systems with universal coverage, where policy makers wish to offer consumers an alternative to universal publicly-financed providers, or where certain medically necessary health services and products are not covered publicly. Yet, policy-makers will need to intervene to address market failures in order to assure PHI access for high-risk groups. In doing so, they can choose from a range of tools. They need to balance the sometimes competing goals of access and the maintenance of a broad and diverse pool of covered lives, particularly in voluntary markets. In addition, governments and insurers should make further strides to ensure meaningful disclosure of policy terms and better dissemination of information in order to enable consumers to make informed decisions between competing PHI products. This would enhance consumer understanding as well as promote transparency and more meaningful competition. Even then, sometimes too great a choice may hamper purchasers’ ability to make informed coverage decisions. Policy makers will need to address some of these issues or they will risk undermining their stated goals.