Abstract
There are numerous studies investigating the effect of health insurance on healthcare utilisation, but there is little empirical evidence examining the effect of private health insurance on objective health outcomes in a universal public health system. Tracking each individual’s health status using panel data, we explore whether there is a difference in the probability of contracting a critical illness or becoming disabled between the privately insured and uninsured. The empirical analysis showed that the incidence of severe disease and disability was 0.76–0.52 times and 0.63–0.31 times lower, respectively, for those with private health insurance. Many theoretical and empirical studies have argued that excessive healthcare utilisation caused by owning health insurance incurs social costs. However, if health insurance lowers the likelihood of serious illness and disability, in the long run, it may lower healthcare utilisation and have a positive effect on human capital and social welfare.
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28 October 2021
A Correction to this paper has been published: https://doi.org/10.1057/s41288-021-00255-1
References
Akerlof, G. 1970. The market for “lemons”: Quality uncertainty and the market mechanism. Quarterly Journal of Economics 84 (3): 488–500. https://doi.org/10.2307/1879431.
Anderson, M. 2012. The effect of health insurance coverage on the use of medical services. American Economic Journal: Economic Policy 4 (1): 1–27. https://doi.org/10.1257/pol.4.1.
Arrow, K.J. 1963. Uncertainty and the welfare economics of medical care. American Economic Review 53 (5): 941–973.
Ayanian, J.Z., B.A. Kohler, T. Abe, and A.M. Epstein. 1993. The relation between health insurance coverage and clinical outcomes among women with breast cancer. The New England Journal of Medicine 329: 326–331. https://doi.org/10.1056/NEJM199307293290507.
Barro, R.J. 2013. Health and economic growth. Annals of Economics and Finance 14 (2): 305–342.
Cameron, A.C., and P.K. Trivedi. 2005. Microeconometrics: Methods and applications. New York: Cambridge University Press.
Dobkin, C., A. Finkelstein, R. Kluender, and M.J. Notowidigdo. 2018. Myth and measurement: The case of medical bankruptcies. New England Journal of Medicine 378 (12): 1076–1078.
Eberhardt, M.S., and E.R. Pamuk. 2004. The importance of place residence: Examining health in rural and nonrural areas. American Journal of Public Health 94 (10): 1682–1686. https://doi.org/10.2105/ajph.94.10.1682.
Einav, L., and A. Finkelstein. 2011. Selection in insurance markets: Theory and evidence in pictures. Journal of Economic Perspectives 25 (1): 115–138. https://doi.org/10.1257/jep.25.1.115.
Einav, L., and A. Finkelstain. 2018. Moral hazard in health insurance: What we know and how we know it. Journal of the European Economic Association 16 (4): 957–982. https://doi.org/10.1093/jeea/jvy017.
Einav, L., A. Finkelstein, S.P. Ryan, P. Schrimpf, and M.R. Cullen. 2013. Selection on moral hazard in health insurance. American Economic Review 103 (1): 178–219. https://doi.org/10.1257/aer.103.1.178.
Ferrante, J.M., E.C. Gonzalez, N. Pal, and R.G. Roetzheim. 2000. Effects of physician supply on early detection of breast cancer. The Journal of the American Board of Family Practice 13 (6): 408–414. https://doi.org/10.3122/15572625-13-6-408.
Geil, P., A. Million, R. Rotte, and K.F. Zimmermann. 1997. Economic incentives and hospitalization in Germany. Journal of Applied Economics 12 (3): 295–311. https://doi.org/10.1002/(SICI)1099-1255(199705)12:3%3C295::AID-JAE443%3E3.0.CO;2-X.
Haddad, G.K., and M.Z. Anbaji. 2010. Analysis of adverse selection and moral hazard in the health insurance market of Iran. The Geneva Papers on Risk and Insurance—Issues and Practice 35: 581–599. https://doi.org/10.1057/gpp.2010.20.
Heintzman, J., G. Rachel, S.R. Bailey, and J.E. DeVoe. 2014. The Oregon experiment re-examined: The need to bolster primary care. British Medical Journal 349: g5976. https://doi.org/10.1136/bmj.g5976.
Jeon, B., and S. Kwon. 2013. Effect of private health insurance on health care utilization in a universal public insurance system: A case of South Korea. Health Policy 113 (1–2): 69–76. https://doi.org/10.1016/j.healthpol.2013.05.007.
Jeong, W. 1998. The brief history of Korean traditional medicine (1899–1999). Korean Journal of Medical History 8 (2): 169–186.
Kim, D.H. 2016. Empirical analysis of maintaining and canceling behaviors of the indemnity private health insurance and its implications. Korea Insurance Journal 108: 29–54.
Kim, D.H., and B.J. Lee. 2013. An analysis on adverse selection in fee-for-service health. Korea Insurance Journal 96: 25–50.
Kim, D.H., and J.R. Roe. 2019. The effect of coverage structure of private health insurance on physician visits between conventional and traditional medicine. Oriental Pharmacy and Experimental Medicine 19 (3): 323–329. https://doi.org/10.1007/s13596-019-00366-0.
Lee-Feldstein, A., P.J. Feldstein, T. Buchmueller, and G. Katterhagen. 2000. The relationship of HMOs, health insurance, and delivery systems to breast cancer outcomes. Medical Care 38 (7): 705–718. https://doi.org/10.1097/00005650-200007000-00003.
Manning, W., J. Newhouse, N. Duan, E. Keeler, A. Leibowitz, and S. Marquis. 1987. Health insurance and the demand for medical care: Evidence from a randomized experiment. American Economic Review 77 (3): 251–277.
Molloy, G.J., E. Stamatakis, G. Randall, and M. Hamer. 2009. Marital status, gender and cardiovascular mortality: Behavioral, psychological distress and metabolic explanations. Social Science & Medicine 69 (2): 223–228. https://doi.org/10.1016/j.socscimed.2009.05.010.
Monfared, E.D. 2017. Cancer trends and the importance of prevention. International Journal of Medical Prevention 4 (4): 98–101.
Nelson, R., and P. Edmund. 1966. Investment in humans, technological diffusion, and economic growth. American Economic Review 56 (1/2): 69–75.
OECD. 2020. Health statistics. http://www.oecd.org/els/health-systems/health-data.htm. Last modified 1 July 2020.
Ossa, D.F., and A. Towse. 2004. Genetic screening, health care and the insurance industry. Should genetic information be made available to insurers? European Journal of Health Economics 5 (2): 116–121.
Park, S., and K. Jeong. 2011. The determinants of private health insurance and its effects on medical utilization in Korea. Korea Insurance Journal 88: 23–49.
Pauly, M.V. 1968. The economics of moral hazard: Comment. American Economics Review 58: 531–537.
Petilliot, R. 2017. The effect of private health insurance on self-assessed health status and health satisfaction in Germany. SOE papers on multidisciplinary panel data research 917, DIW Berlin, The German Socio-Economic Panel (SOEP).
Pohlmeier, W., and V. Ulrich. 1995. An econometric model of the two-part decisionmaking process in the demand for health care. The Journal of Human Resources 30 (2): 339–361. https://doi.org/10.2307/146123.
Riphahn, R.T., A. Wambach, and A. Million. 2003. Incentive effects in the demand for health care: A bivariate panel count data estimation. Journal of Applied Economics 18 (4): 387–405. https://doi.org/10.1002/jae.680.
Roetzheim, R.G., N. Pal, C. Tennant, L. Voti, J.Z. Ayanian, A. Schwabe, and J.P. Krischer. 1999. Effects of health insurance and race on early detection of cancer. Journal of the National Cancer Institute 91 (16): 1409–1415. https://doi.org/10.1093/jnci/91.16.1409.
Romer, P.M. 1990. Endogenous technological change. Journal of Political Economy 98 (5): S71–S102. https://doi.org/10.1086/261725.
Ross, C., J. Mirowsky, and K. Goldsteen. 1990. The impact of the family on health: The decade in review. Journal of Marriage and the Family 52: 1059–1078. https://doi.org/10.2307/353319.
Rothschild, M., and J. Stiglitz. 1976. Equilibrium in competitive insurance markets: An essay on the economics of imperfect information. Quarterly Journal of Economics 90 (4): 629–649. https://doi.org/10.2307/1885326.
Simon, K.I. 2005. Adverse selection in health insurance markets? Evidence from state-group health insurance reforms. Journal of Public Health 89 (9–10): 1865–1877. https://doi.org/10.1016/j.jpubeco.2004.07.003.
Statistics Korea. 2020. Statistics of death causes in 2019 in Korea. Press Release.
Szumilas, M. 2010. Explaining odds ratios. Journal of the Canadian Academy of Child and Adolescent Psychiatry 19 (3): 227–229.
Wharam, J.F., A.B. Busch, J. Madden, F. Zhang, M. Callahan, R.F. LeCates, P. Foxworth, S. Soumerai, D. Ross-Degnan, and C.Y. Lu. 2020. Effect of high-deductible insurance on health care use in bipolar disorder. The American Journal of Medical Care 26 (6): 248–255. https://doi.org/10.37765/ajmc.2020.43487.
World Health Organization. 2005. Sustainable health financing, universal coverage and social health insurance. World Health Assembly Resolution 58: 33.
You, C.H., and J.D. Kim. 2011. A study on the determinants of purchasing and surrendering private health insurance. The Journal of Risk Management 22: 198–222.
Zajacova, A., and E.M. Lawrence. 2018. The relationship between education and health: Reducing disparities through a contextual approach. Annual Review of Public Health 1 (39): 273–289.
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This research is funded by Dong-A University.
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Kim, D., Lee, Dh. Does private health insurance prevent the onset of critical illness and disability in a universal public insurance system?. Geneva Pap Risk Insur Issues Pract 48, 177–193 (2023). https://doi.org/10.1057/s41288-021-00251-5
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DOI: https://doi.org/10.1057/s41288-021-00251-5