Private Expenditure on Health and Voluntary Private Health Insurance

In this thesis, several issues relating to private expenditure on health and voluntary private health insurance (PHI) are being discussed. The two themes are closely linked since expenditure covered by PHI is a part of private expenditure on health. The other part is out-of-pocket expenditure on health.
In the European Union (EU), private expenditure represents -on average- 21 per cent of total expenditure on health. Three quarters of private expenditure on health is financed out-of-pocket. PHI finances only 5 per cent of total health spending in the EU.
Out-of-pocket expenditure on health may negatively affect access to health care. Especially people on low incomes and in poor health are at risk. They may postpone or forgo necessary treatment because they are not able to pay the bill. In this study, we have focused on two issues relating to out-of-pocket expenditure on health: (i) extra payments guaranteeing free choice of provider (supplementary fees) and (ii) extra payments guaranteeing access to new health technology.
Voluntary private health insurance (PHI) can reduce the financial risk related to private health spending. In this thesis, two issues relating to PHI have been addressed: (i) regulation of PHI markets and (ii) optimal design of PHI products.