Redistribution through social health insurance: evidence on citizen preferences
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The extent of social health insurance (SHI) and supplementary private insurance is frequently analyzed in public choice. Most of these analyses build on the model developed by Gouveia (1997), who defines the extent of SHI as consequence of a choice by self-interested voters. In this model, an indicator reflecting individuals’ relative income position and relative risk of falling ill determines the voting decision. Up to now, no empirical evidence for this key assumption has been available. We test the effect of this indicator on individuals’ preferences for the extent of SHI in a setting with mandatory SHI that can be supplemented by private insurance. The data is based on a DCE conducted in the field with a representative sample of 1538 German citizens in 2012. Conditional logit and latent class models are used to analyze preference heterogeneity. Our findings strongly support the assumptions of the models. Individuals likely to benefit from public coverage show a positive marginal willingness to pay (MWTP) for both a shift away from other beneficiary groups toward the sick and an expansion of publicly financed resources, and the expected net payers have a negative MWTP and prefer lower levels of public coverage.
KeywordsSocial health insurance Preferences Discrete choice experiment
JEL ClassificationH23 H51 I13 C93
We thank three anonymous referees for very helpful comments and suggestions. The authors gratefully acknowledge financial support from the German Research Foundation (DFG). We are also grateful to Martina Wagner for her assistance in preparing the discrete choice experiment as well as the socioeconomic questionnaire. We would also like to thank Pedro Pita Barros, Albert Ma, Marlies Ahlert, Tor Iversen, Matthias Kifmann, Laura Birg and the conference participants at the 2014 Meeting of the iHEA/ECHE in Dublin, the 2013 Annual Meeting of the German Association of Health Economics (dggö) in Essen, the 2013 Meeting of the NHESG in Oslo as well as seminar participants at the CINCH summer school in Essen, the Brown-Bag seminar at the University of Bayreuth and the DIBOGS seminar in Düsseldorf for helpful comments and suggestions. All remaining errors are ours. The study was funded by the German Research Foundation (DFG): UL163/4-2.
Conflict of interest
No potential conflicts of interest exist.
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