Voluntary private health insurance demand by Portuguese seniors before the COVID‐19 pandemic

• Published in: The International journal of health planning and management Vol. 38; no. 2; pp. 494 - 506
• Main Author: Tavares, Aida Isabel
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2023
• Subjects: Aged; Aged, 80 and over; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; Dental care; determinants; Female; Health care; Health care access; Health insurance; Health services; Health Services Accessibility; Health surveys; Humans; Insurance; Insurance Coverage; Insurance, Health; Male; NHS; Older people; Oral health; Pandemics; Portugal; Portugal - epidemiology; seniors; State Medicine; voluntary private health insurance; Portugal; NHS; determinants; Portugal; seniors; voluntary private health insurance
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.3601

Aims
The Portuguese health system is mainly described as a National Health Service (NHS), but it also has some Bismarckian features. On top of these two layers of health insurance coverage, there is a market for voluntary private health insurance (VPHI). Usually, seniors are not eligible for this type of health insurance and this may serve as a complement or supplement to the NHS. The purpose of this work is to identify the main factors associated with holding a VPHI policy among seniors before the COVID‐19 pandemic.
Material and Methods
We use data collected by the National Health Survey of 2019/20 and estimate a multivariate logistic regression.
Results
The main findings show that VPHI may be bought by seniors as a facilitator to access health care, either specialised or dental care. While oral health is not covered by the NHS, specialist care is only available after referral by a gatekeeper and requires a long waiting time to be scheduled. Results show that people who had an appointment with a dentist or a specialist in the last 12 months are more likely to have a VPHI policy. Additionally, it was found that people benefiting from occupation‐based insurance schemes are less likely to buy private health insurance.
Conclusion
The current Portuguese health system organization based on different layers of health protection raises some issues concerning equity to health care access by seniors.
Highlights
a small share of seniors buys voluntary private health insurance (VPHI)
higher income and higher level of education increase the likelihood of holding VPHI
benefiting from occupation‐based insurance schemes reduce the likelihood of having private health insurance
VPHI seems to complement and supplement the National Health Service (NHS)
seniors with private health insurance are more likely to access specialists and dentists