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Public versus private access in the Italian NHS - The use of propensity score matching to provide more insight on the increasing adoption of voluntary health insurance

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  • Brenna, Elenka

Abstract

In the Italian NHS, over the last decades, a growing share of population opted for a Voluntary Health Insurance (VHI) in order to privately access healthcare services and bypass the increasingly long waiting times of the public system.

Suggested Citation

  • Brenna, Elenka, 2025. "Public versus private access in the Italian NHS - The use of propensity score matching to provide more insight on the increasing adoption of voluntary health insurance," Health Policy, Elsevier, vol. 154(C).
  • Handle: RePEc:eee:hepoli:v:154:y:2025:i:c:s0168851025000272
    DOI: 10.1016/j.healthpol.2025.105271
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    1. Rong Fu & Haruko Noguchi, 2019. "Moral hazard under zero price policy: evidence from Japanese long-term care claims data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(6), pages 785-799, August.
    2. Dardanoni V & Li Donni P, 2009. "The Effect Of Supplemental Insurance On Health Care Demand With Multiple Information: A Latent Class Analysis," Health, Econometrics and Data Group (HEDG) Working Papers 09/03, HEDG, c/o Department of Economics, University of York.
    3. Aida Isabel Tavares & Inês Marques, 2021. "Multi-layer health insurance coverage, medical services use and health in a Universal National Health System, the case of Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(1), pages 141-153, February.
    4. Powell, David & Goldman, Dana, 2021. "Disentangling moral hazard and adverse selection in private health insurance," Journal of Econometrics, Elsevier, vol. 222(1), pages 141-160.
    5. James J. Heckman & Hidehiko Ichimura & Petra E. Todd, 1997. "Matching As An Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 605-654.
    6. Andrea Ichino & Fabrizia Mealli & Tommaso Nannicini, 2008. "From temporary help jobs to permanent employment: what can we learn from matching estimators and their sensitivity?," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 23(3), pages 305-327.
    7. Ángel Marcos Vera‐Hernández, 1999. "Duplicate coverage and demand for health care. The case of Catalonia," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 579-598, November.
    8. Anthony T. Lo Sasso & Bruce D. Meyer, 2006. "The Health Care Safety Net and Crowd-Out of Private Health Insurance," Working Papers 0417, Harris School of Public Policy Studies, University of Chicago.
    9. Denise Doiron & Glenn Jones & Elizabeth Savage, 2008. "Healthy, wealthy and insured? The role of self‐assessed health in the demand for private health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 317-334, March.
    10. Marenzi, Anna & Rizzi, Dino & Zanette, Michele, 2021. "Incentives for voluntary health insurance in a national health system: Evidence from Italy," Health Policy, Elsevier, vol. 125(6), pages 685-692.
    11. Brenna, Elenka & Giammanco, Maria Daniela, 2024. "The use of voluntary health insurance in the access to specialist care: Evidence from the Italian NHS," Socio-Economic Planning Sciences, Elsevier, vol. 93(C).
    12. Daniele Fabbri & Chiara Monfardini, 2016. "Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 78(1), pages 75-93, February.
    13. Guo, Shenyang & Barth, Richard P. & Gibbons, Claire, 2006. "Propensity score matching strategies for evaluating substance abuse services for child welfare clients," Children and Youth Services Review, Elsevier, vol. 28(4), pages 357-383, April.
    14. Signorelli, C. & Odone, A. & Oradini-Alacreu, A. & Pelissero, G., 2020. "Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary," Health Policy, Elsevier, vol. 124(1), pages 69-74.
    15. Omar Paccagnella & Vincenzo Rebba & Guglielmo Weber, 2013. "VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 289-315, March.
    16. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    17. Marisol Rodríguez & Alexandrina Stoyanova, 2004. "The effect of private insurance access on the choice of GP/specialist and public/private provider in Spain," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 689-703, July.
    18. Elisa Luciano & J François Outreville & Mariacristina Rossi, 2016. "Life Insurance Ownership by Italian Households: A Gender-Based Differences Analysis," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 41(3), pages 468-490, July.
    19. Brenna, Elenka, 2011. "Quasi-market and cost-containment in Beveridge systems: The Lombardy model of Italy," Health Policy, Elsevier, vol. 103(2), pages 209-218.
    20. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    21. Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, vol. 22(1), pages 31-72, February.
    22. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    23. Christy Spivey, 2010. "Desperation Or Desire? The Role Of Risk Aversion In Marriage," Economic Inquiry, Western Economic Association International, vol. 48(2), pages 499-516, April.
    24. Meer, Jonathan & Rosen, Harvey S., 2004. "Insurance and the utilization of medical services," Social Science & Medicine, Elsevier, vol. 58(9), pages 1623-1632, May.
    25. Xiangping Liu & Danijel Nestic & Tomislav Vukina, 2012. "Estimating Adverse Selection And Moral Hazard Effects With Hospital Invoices Data In A Government‐Controlled Healthcare System," Health Economics, John Wiley & Sons, Ltd., vol. 21(8), pages 883-901, August.
    26. Besley, Timothy & Coate, Stephen, 1991. "Public Provision of Private Goods and the Redistribution of Income," American Economic Review, American Economic Association, vol. 81(4), pages 979-984, September.
    27. Kullberg, Linn & Blomqvist, Paula & Winblad, Ulrika, 2019. "Health insurance for the healthy? Voluntary health insurance in Sweden," Health Policy, Elsevier, vol. 123(8), pages 737-746.
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    More about this item

    Keywords

    Voluntary health insurance; Italian NHS; Equity of access; Outpatient services; Propensity score matching;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • H44 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Goods: Mixed Markets
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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