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Public health care and private insurance demand: The waiting time as a link

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Abstract

This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990–91 as a complementary data set, following the Arellano–Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market.

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References

  1. Amemiya, Qualitative response models: a survey, Journal of Economic Literature 19(4) (1981) 481–536.

    Google Scholar 

  2. J.J. Artells Herrero, Contexto de Política y Direcciones de Cambio para el Sistema Sanitario, in: La Colaboración del Seguro Sanitario Privado en la Gestión del Aseguramiento Público, II Jornada Técnica sobre Economía de Salud y Aseguramiento Sanitario, A & S Economía de la Salud, Emep Gráficas SA, Barcelona (1994).

    Google Scholar 

  3. J.J. Artells Herrero, Contexto de Dinámica del Aseguramiento Sanitario en el Entorno Internacional, in: I Jornada Técnica sobre Economía de Salud y Aseguramiento Sanitario, A & S Economía de la Salud, Emep Gráficas SA, Barcelona (1993).

    Google Scholar 

  4. Arellano and Meghir, Female labour supply and on-the-job search: An empirical model estimated using complementary data sets, Review of Economic Studies 59 (1992) 537–557.

    Article  Google Scholar 

  5. L.M. ´ Avalos-Muñoz and A. Romero-Gago, Análisis estructural de los seguros de asistencia sanitaria y enfermedad en España, Article (1997).

  6. P.P. Barros, R. Castro, M. Duarte and S. Goncalves, From public to private health insurance: what the taxman shouldn't do, presented at the 3rd European Health Economics Conference (1995).

  7. Y. Barzel, A theory of rationing by waiting, Journal of Law and Economics 17 (1974) 73–95.

    Article  Google Scholar 

  8. Besley, Hall and Preston, The demand for private health insurance in the UK: Do the waiting lists matter?, mimeo, Institute of Fiscal Studies, London (1996).

    Google Scholar 

  9. A. Blomqvuist and H. Horn, Public health insurance and optimal income taxation, Journal of Public Economics 24(3) (1984) 353–371.

    Article  Google Scholar 

  10. Cullis and Jones, Rationing by waiting lists: An implication, American Economic Review 76 (1986) 250–256.

    Google Scholar 

  11. J. Currie and J. Gruber, The technology of birth: Health insurance, medical interventions, and infant health, seminar presented at the BU-Harvard-MIT Health Economics Seminars (1996).

  12. D. Cutler and J. Gruber, Does public insurance crowd out private insurances?, Quarterly Journal of Economics (1996) CXI.

  13. Deacon and Sonstelie, Rationing by waiting and the value of time: Evidence from a natural experiment, Journal of Political Economy 93(4) (1985) 627–647.

    Article  Google Scholar 

  14. Deacon and Sonstelie, The welfare costs of rationing by waiting, Economic Inquiry 27(2) (1989) 179–196.

    Article  Google Scholar 

  15. J. Elola, Sistemas de Salud: Evaluación de su Eficiencia y Alternativas de Reforma (SG Editores, Barcelona, 1994).

    Google Scholar 

  16. Encuesta de Presupuestos Familiares 1990-91, Instituto Nacional de Estadística, Principales Resultados, Madrid (1994).

  17. Encuesta Nacional de Salud, Ministerio de Sanidad y Consumo, Metodología, Principales Resultados, Madrid (1994).

    Google Scholar 

  18. Epple and Romano, Public Provision of Private Goods 104(1) (1996) 57–84.

    Google Scholar 

  19. Feldman, The cost of rationing the medical care by insurance coverage and by waiting, in: Health Economics, Vol. 3 (1994) pp. 361–372.

    Google Scholar 

  20. P. Gertler and R. Sturm, Using private health insurance to reduce and better target public health expenditures, Rand Working Paper, 94-27, DRU-886-NICHD (1994).

  21. J.A. Goddard, M. Malek and M. Tavakoli, An economic model of the market for hospital treatment for non-urgent conditions, Health Economics 4 (1995) 41–55.

    Google Scholar 

  22. Y. González, La demanda de seguro sanitario: Una aplicación al caso español, Cambios en la Regulación Sanitaria, XIV Jornadas de Economía de la Salud, Asociación de Economía de la Salud, SG Editores SA, Barcelona (1995).

    Google Scholar 

  23. Gouveia, Majority rule and the public provision of health care, mimeo, University of Pennsylvania, CARESS Working Paper (1993) pp. 93–26.

  24. W.H. Greene, Econometric Analysis, 2nd. ed. (MacMillan, New York, 1993) 245 pp.

    Google Scholar 

  25. P.J. Huber, The behavior of maximum likelihood estimates under non-standard conditions, in: Proceedings of the 5th Berkeley Symposium on Mathematical Statistics and Probability, Berkeley, CA (University of California Press, 1967) vol. 1, pp. 221–223.

    Google Scholar 

  26. Informe NERA, El Sistema Sanitario Español: Alternativas para su Reforma, Madrid (1996).

  27. Informe SESPAS, La salud y el sistema sanitario en España, SG Editores SA, Barcelona (1993).

    Google Scholar 

  28. Ireland, The mix of social and private provision of goods and services, Journal of Public Economics 43(2) (1990) 201–219.

    Article  Google Scholar 

  29. T. Iversen, A theory of hospital waiting lists, Journal of Health Economics 12 (1993) 55–71.

    Article  Google Scholar 

  30. M. Jofre-Bonet and R. Urbanos-Garrido, Waiting lists and private insurance in Spain, paper presented at the International Conference on Health Economics, Evora, Portugal (October 1997).

  31. G. López-Casasnovas, Público y Privado en Sanidad. Claves y Estrategias de análisis, Cambios en la Regulación Sanitaria, XIV Jornadas de Economía de la Salud, Asociación de Economía de la Salud, SG Editores SA, Barcelona (1994).

    Google Scholar 

  32. G. López-Casasnovas, La interrelación de lo público y lo privado en sanidad desde la perspectiva de la adopción de políticas sanitarias: algunas reflexiones contextuales, in: Política y Gestión Sanitaria: La Agenda Expí?cita, Asociación de la Economía de la Salud, eds. R. Meneu and V. Ortún (1996).

  33. G. López-Casanovas and M. Jofre-Bonet, El seguro sanitario dentro del sistema sanitario español, Todo Hospital (1995) 115.

  34. G. López-Casanovas, Escenarios de Colaboración del Seguro Privado con el Sistema Público, La Colaboración del Seguro Sanitario Privado en la Gestión del Aseguramiento Público, II Jornada Técnica sobre Economía de Salud y Aseguramiento Sanitario, A & S Economía de la Salud, Emep Gráficas S, Barcelona (1994).

    Google Scholar 

  35. C. Murillo, El mercado de los Seguros Sanitarios privados, I Jornada Técnica sobre Economía de Salud y Aseguramiento Sanitario, A & S Economía de la Salud, Emep Gráficas SA, Barcelona (1993).

    Google Scholar 

  36. C. Murillo, S. Calonge and Y. González, La Financiación Privada de los Servicios Sanitarios, in: La Regulación de los Servicios en España (FEDEA, Madrid, 1996).

    Google Scholar 

  37. J.P. Newhouse, Cream-skimming, asymmetric information, and a competitive insurance market, Journal of Health Economics 3(1) (1994).

  38. D. Nichols, E. Smolensky and T.N. Tideman, Discrimination by waiting time in merit goods, The American Economic Review 61 (1971) 312–323.

    Google Scholar 

  39. G.S. Olley and A. Pakes, The dynamics of productivity in the telecommunications equipment industry, Econometrica 64 (1996) 6.

    Article  Google Scholar 

  40. L. Pellissé, Regulación de competencia en el mercado de seguros sanitarios español: Capitación y selección de riesgos en MUFACE, Poltica y Gestión Sanitaria: La Agenda Explícita, Asociación de la Economía de la Salud, ed. R. Meneu and V. Ortún (1996).

  41. C. Propper, An econometric analysis of the demand for private health insurance in England and Wales, Applied Economics 21(6) (1989) 777–792.

    Google Scholar 

  42. A. Pulido, Modelos Econométricos (Ediciones Pirámide SA, 1983) p. 232.

  43. Roigé et al., Paper presented at the IX Jornadas de Salud Pública y Administración Sanitaria, EASP, Granada, (1994).

    Google Scholar 

  44. M. Segura-Bonet, Labour supply behavior, Dissertation, Universitat Pompeu Fabra, Barcelona (1996).

    Google Scholar 

  45. R.J. Smith and R.W. Blundell, An exogeneity test for a simultaneous equation tobit model with an application to labor supply, Econometrica 54(3) (1986).

  46. Sonstelie, The welfare cost of public schools, Journal of Political Economy 90(4) (1982) 794–808.

    Article  Google Scholar 

  47. Stiglitz, The demand for education in public and private school systems, Journal of Public Economics 3(4) (1974) 349–385.

    Article  Google Scholar 

  48. T. Szabó, La demanda de seguros médicos privados y el uso de servicios sanitarios en España, Thesis CEMFI # 9706 (June 1997).

  49. H. White, A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity, Econometrica 48(4) (1980) 817–38.

    Article  Google Scholar 

  50. W. van de Ven and R. van Vliet, How can we prevent creamskimming in a competitive health insurance market?, in: Health Economics Worldwide, eds. P. Zweifel and H.E. Rech III (Kluwer Academic, 1992).

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Jofre-Bonet, M. Public health care and private insurance demand: The waiting time as a link. Health Care Management Science 3, 51–71 (2000). https://doi.org/10.1023/A:1019024903898

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