Waiting times and other barriers to health care access

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1 Dr. Frank Niehaus Wissenschaftliches Institut der PKV (Scientific Research Institute of the Association of German Private Health Insurers) Waiting times and other barriers to health care access

2 31.8 % of total population Coverage for health care Most OECD-countries provide universal health insurance coverage for a core set of services Government/Social health insurance Primary private health insurance coverage

3 Why is the health care market not a normal market? Price Supply P G The normal market Demand Q G Quantity

4 Why is the health care market not a normal market? Price Supply P fixed fixed price below equilibrium Demand Q supplied Q demand Quantity Nearly in all health systems the health care market is reglemented by fixed prices systems for health care providers and the access for patients is (nearly) cost free. As a consequence, the demand exceeds the supply.

5 Why are there barriers to health care access like waiting times? The price mechanism as a rationing tool is eliminated. Other allocative mechanisms replace the price mechanism. So every health care system has rationing tools such as waiting times gatekeeping positive/negative lists (included/excluded health care services) copayments etc.

6 Sweden United Kingdom Australia (2010) Denmark Ireland Italy Canada Portugal Spain New Zealand Norway Finland Iceland Austria Greece Switzerland Israel Korea Luxembourg Hungary Poland Belgium Estonia Japan (2010) Germany Slovakia Netherlands Czech Republic Slovenia France Countries with official statistics on waiting times and lists Waiting times and health system financing (2011) % 90% 80% 70% 60% 50% 40% Social insurance contributions (%) Taxes (%) 30% 20% 10% 0% Official statistics on waiting times and lists yes no

7 Waiting times in hospitals - Example United Kingdom National Health Service financed by taxes 5.5 Millionen people are listed on list for a treatmend (8.6 % of the population)

8 Waiting times in hospitals - Example Netherlands Health system financed by contributions and flat-rate health premiums

9 Private Health Insurance as an indicator of the gap in health care system? Private Health Insurance (PHI)can only be established if there is a need for services The market for PHI indicates that there are an unmet demand for health care services If PHI is established: More people with restricted financial resources can protect against the risk of illness Less disparities in health care (compared to out-of-pocket-payment)

10 How can the existente of Private Health Insurance be interpreted? Type and extent of Private Health Insurance shows gaps in the health care system of a country serves as an indicator of health disparities

11 Types of Private Health Insurance (PHI) Type of Private Health Insurance (PHI) Duplicate (alternative) PHI Features and form of rationing that promotes the type of insurance Provides access to the same health benefits as the public system via private settlement of (private) doctors and (private) clinics Waiting times, gatekeeping and lack of quality in the public health system Supplementary (additional) PHI Coverage of services that are excluded from the public system, e.g. no reimbursement of dental treatment, drugs, single room or chief physician at the hospital Complementary (completing) PHI Coverage of copayments in the public health system

12 Duplicate Private Health Insurance as response to waiting times and barriers to access Example United Kingdom Public tax-financed health care system Long waiting times: 5.5 million people are on waiting lists (8.6 % of population) Use of primary care physicians as gatekeepers to specialists and other medical resources Well-developed private sector parallel to public sector Market for duplicate Private Health Insurance 11.1 % of Britons have such an insurance

13 Duplicate Private Health Insurance as response to waiting times and barriers to access Example Spain Public tax-financed health care system Strict gatekeeping Long waiting times Private sector parallel to public sector Market for duplicate Private Health Insurance 13 % of Spaniards have insurance for private medical treatment

14 Duplicate Private Health Insurance as response to waiting times and barriers to access Duplicate Private Health Insurance is most commonly found in tax-financed health care systems, e.g. in: Australia Denmark Finland Ireland Italy Norway Portugal Spain Sweden United Kingdom But also in some health systems funded by contributions: Austria Luxembourg Poland

15 Complementary Private Health Insurance as response to co-payments Example France Health system financed by contributions and taxes High copayments (on avarage 30 % of the treatment costs) Market for complementary Private Health Insurance 96 % of the French population have such an insurance

16 Supplementary Private Health Insurance as response to reduction of benefits Example Netherlands Health system financed by contributions and flat-rate health premiums Dental care (from age 22), psychotherapy and physiotherapy are not covered Market for supplementary Private Health Insurance 86 % of the Dutch population have supplementary Private Health Insurance for dental and orthodontic treatment 71 % have supplementary Private Health Insurance for physiotherapy

17 Supplementary Private Health Insurance as response to reduction of benefits Example Switzerland Health system financed by flat-rate health premiums Dental care is not covered Market for supplementary Private Health Insurance 29,5 % (2007) of the Swiss population have such an insurance

18 Proportion of population with private health insurance (PHI) in 2010 France 96.0 % Netherlands 89.0 % Belgium 78.9 % Canada 68.0 % Luxembourg 55.2 % Australia 52.4 % Ireland 49.8 % Austria 33.9 % New Zealand 31.6 % Switzerland (2007) 29.5 % Germany 20.2 % Spain (2009) 19.7 % Denmark 19.6 % Portugal 19.6 % Finland (2006) 11.4 % United Kingdom (2006) 11.1 % Source: OECD Health Data 2012 Dissemination of insurance depends on: Extent of supply Type of Coverage Level of the premium Expansion of private provision of services If needed, complementary and supplementary Private Health Insurances are widespread. Duplicate insurance is relatively expensive: exclusive group of clients

19 Conclusion The market mechanism is eliminated in nearly all public health systems. Other rationing mechanisms such as waiting times replace the price mechanism. Waiting times mainly occur in tax-financed health systems. Private Health Insurance reveals the gaps in the public health system. Duplicate Private Health Insurance is a response to waiting times and access barriers in the public health system. Duplicate Private Health Insurance covers the costs of private treatment and therefore provides faster access.

20 Thank you for your attention!

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