Multi-layer health insurance coverage, medical services use and health in a Universal National Health System, the case o
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ORIGINAL PAPER
Multi‑layer health insurance coverage, medical services use and health in a Universal National Health System, the case of Portugal Aida Isabel Tavares1,2 · Inês Marques2 Received: 2 March 2020 / Accepted: 24 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The Portuguese health system has the peculiar characteristic of being a Beveridge–Bismarck type aiming at universal coverage. On top of the national health system coverage, there is a second coverage provided to some professionals, plus a third layer of coverage that can be acquired by taking out voluntary private health insurance. The aim of this work is to ascertain whether people benefiting from supplemental multi-layer health coverage (on top of the existing National Health System) have more consultations, either with general practitioners or with specialists, and enjoy better health status. We used data from the National Health Survey from 2014 to estimate a recursive system of ordered probits. The main results confirm that multi-layer health coverage is correlated with the use of more specialist consultations, but not with more GP consultations. It is also correlated with better health status. These results may indicate the existence of moral hazard, induced demand and/or ’access effect’. Regarding policy matters, the measures aimed to reduce waiting times, improve patient choice, and increase access could counteract such results and mitigate the potential inequity of access and health status, and also excessive use of medical services that can happen under double health coverage. Keywords Health insurance · Coverage · Utilization · Health JEL Classification I11 · I13
Introduction The Portuguese health system is a universal coverage system created in 1979. It is mainly structured as a tax-based (or Beveridge) system and so is defined as a national health system (NHS). This type of health system has several drawbacks, such as, difficulty gaining access to specialists due to gatekeeping, long waiting lists, and no freedom of choice for patients [23]. However, the Portuguese health system has a unique feature due its historical heritage. The NHS Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10198-020-01242-4) contains supplementary material, which is available to authorized users. * Aida Isabel Tavares [email protected] 1
ISEG, Lisbon School of Economics and Management, Lisbon, Portugal
CEISUC, Centre of Studies and Research in Health of the University of Coimbra, Coimbra, Portugal
2
co-exists with features of the Bismarck model, where some professionals pay a contribution to a social health insurance. These professionals include civil servants, the armed forces, and bank employees. So, these individuals benefit from a second layer of coverage, on top of the tax-funded NHS (the double coverage health insurance or DCHI) financed by income-based contributions. These occupation-based health insurance schemes can be public, like those for c
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