December 21, 2010

CSSRR Health–December 21, 2010

Filed under: H. NGO and Other Countries,H. Working Papers,Health — admin @ 4:52 pm


Institute for Research and Information in Health Economics [IRDES] Working Papers:

A. “Disparities in Regular Health Care Utilisation in Europe,” by Nicolas Sirven and Zeynep Or (IRDES Working Paper No. 37, December 2010, .pdf format, 19p.).


Despite common recommendations and quasi universal health care coverage in all European countries, there are large differences in the utilisation patterns of different health services. Little comparative information is available on different types of health service utilisation and variations in utilisation patterns over a longer time span. The objective of this study is to compare and investigate individual and cross-country determinants of health care utilisation habits over the life span across European countries. We found that while there is a general shift toward more regular and preventive care utilisation in all countries; there are still signifi cant social inequalities between countries and cohorts. There is also evidence that once the individual effects have been isolated, cross-cohort and country differences in the prevalence of regular care use are partly associated with differences in welfare states interventions.


B. “Subscribing to Supplemental Health Insurance in France: A Dynamic Analysis of Adverse Selection,” by Carine Franc, Marc Perronnin, and Aurelie Pierre (IRDES Working Paper No. 35, December 2010, .pdf format, 17p.).


Adverse selection, which is well described in the theoretical literature on insurance, remains relatively difficult to study empirically. The traditional approach, which focuses on the binary decision of ‘covered’ or ‘not’, potentially misses the main effects because heterogeneity may be very high among the insured. In the French context, which is characterized by universal but incomplete public health insurance (PHI), we study the determinants of the decision to subscribe to supplemental health insurance (SHI) in addition to complementary health insurance (CHI). This work permits to analyze health insurance demand at the margin. Using a panelized dataset, we study the effects of both individual state of health, which is measured by age and previous individual health spending, and timing on the decision to subscribe. One striking result is the changing role of health risk over time, illustrating that adverse selection occurs immediately after the introduction of SHI. After the initial period, the effects of health risks (such as doctors’ previous health expenditures) diminish over time and financial risks (such as dental and optical expenses and income) remain significant. These results may highlight the inconsistent effects of health risks on the demand for insurance and the challenges of studying adverse selection.


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