IDEAS home Printed from https://ideas.repec.org/a/spr/empeco/v68y2025i4d10.1007_s00181-024-02680-2.html
   My bibliography  Save this article

Private health insurance and health in a healthcare system with comprehensive public insurance

Author

Listed:
  • Elizabeth Baldwin

    (The University of Queensland)

  • Jonas Fooken

    (Macquarie University
    The University of Queensland)

  • David Rowell

    (The University of Queensland)

Abstract

A large literature shows that attaining private health insurance (PHI) improves the health of individuals who do not have access to healthcare that is provided free of charge. However, even when individuals already benefit from public health insurance, complementary and supplementary PHI may benefit population health. We study the association between health and PHI for hospital care in Australia that individuals purchase in addition to a comprehensive public health insurance and the provision of free care in public hospitals. We find that hospital PHI holders have better health but identify no significant relationship between attaining hospital PHI or between policy-induced PHI and health.

Suggested Citation

  • Elizabeth Baldwin & Jonas Fooken & David Rowell, 2025. "Private health insurance and health in a healthcare system with comprehensive public insurance," Empirical Economics, Springer, vol. 68(4), pages 2009-2040, April.
  • Handle: RePEc:spr:empeco:v:68:y:2025:i:4:d:10.1007_s00181-024-02680-2
    DOI: 10.1007/s00181-024-02680-2
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s00181-024-02680-2
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s00181-024-02680-2?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Nathan Kettlewell & Olena Stavrunova & Oleg Yerokhin, 2018. "Premium subsidies and demand for private health insurance: results from a regression discontinuity design," Applied Economics Letters, Taylor & Francis Journals, vol. 25(2), pages 96-101, January.
    2. 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.
    3. Michael Baker & Mark Stabile & Catherine Deri, 2004. "What Do Self-Reported, Objective, Measures of Health Measure?," Journal of Human Resources, University of Wisconsin Press, vol. 39(4).
    4. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust Nonparametric Confidence Intervals for Regression‐Discontinuity Designs," Econometrica, Econometric Society, vol. 82, pages 2295-2326, November.
    5. Nathan Kettlewell & Yuting Zhang, 2024. "Age penalties and take‐up of private health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 33(4), pages 636-651, April.
    6. Barbaresco, Silvia & Courtemanche, Charles J. & Qi, Yanling, 2015. "Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults," Journal of Health Economics, Elsevier, vol. 40(C), pages 54-68.
    7. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    8. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    9. Dolores De La Mata, 2012. "The Effect Of Medicaid Eligibility On Coverage, Utilization, And Children'S Health," Health Economics, John Wiley & Sons, Ltd., vol. 21(9), pages 1061-1079, September.
    10. Johnston, David W. & Propper, Carol & Shields, Michael A., 2009. "Comparing subjective and objective measures of health: Evidence from hypertension for the income/health gradient," Journal of Health Economics, Elsevier, vol. 28(3), pages 540-552, May.
    11. Charles J. Courtemanche & Daniela Zapata, 2014. "Does Universal Coverage Improve Health? The Massachusetts Experience," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 33(1), pages 36-69, January.
    12. Hanming Fang & Michael P. Keane & Dan Silverman, 2008. "Sources of Advantageous Selection: Evidence from the Medigap Insurance Market," Journal of Political Economy, University of Chicago Press, vol. 116(2), pages 303-350, April.
    13. Jay Pan & Xiaoyan Lei & Gordon G. Liu, 2016. "Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention," Health Economics, John Wiley & Sons, Ltd., vol. 25(11), pages 1389-1402, November.
    14. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    15. Alfons Palangkaraya & Jongsay Yong & Elizabeth Webster & Peter Dawkins, 2009. "The income distributive implications of recent private health insurance policy reforms in Australia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(2), pages 135-148, May.
    16. Damien S. Eldridge & Ilke Onur & Malathi Velamuri, 2017. "The impact of private hospital insurance on the utilization of hospital care in Australia," Applied Economics, Taylor & Francis Journals, vol. 49(1), pages 78-95, January.
    17. Marika Cabral & Neale Mahoney, 2019. "Externalities and Taxation of Supplemental Insurance: A Study of Medicare and Medigap," American Economic Journal: Applied Economics, American Economic Association, vol. 11(2), pages 37-73, April.
    18. Stavrunova, Olena & Yerokhin, Oleg, 2014. "Tax incentives and the demand for private health insurance," Journal of Health Economics, Elsevier, vol. 34(C), pages 121-130.
    19. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    20. Weathers, Robert R. & Stegman, Michelle, 2012. "The effect of expanding access to health insurance on the health and mortality of Social Security Disability Insurance beneficiaries," Journal of Health Economics, Elsevier, vol. 31(6), pages 863-875.
    21. Amy Finkelstein & Kathleen McGarry, 2006. "Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 96(4), pages 938-958, September.
    22. Torben Heien Nielsen, 2016. "The Relationship Between Self‐Rated Health and Hospital Records," Health Economics, John Wiley & Sons, Ltd., vol. 25(4), pages 497-512, April.
    23. Michael Anderson & Carlos Dobkin & Tal Gross, 2012. "The Effect of Health Insurance Coverage on the Use of Medical Services," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 1-27, February.
    24. Kristjana Einarsdóttir & Anna Kemp & Fatima A Haggar & Rachael E Moorin & Anthony S Gunnell & David B Preen & Fiona J Stanley & C D’Arcy J Holman, 2012. "Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-5, July.
    25. Carol Propper, 1995. "The Disutility of Time Spent on the United Kingdom's National Health Service Waiting Lists," Journal of Human Resources, University of Wisconsin Press, vol. 30(4), pages 677-700.
    26. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 597-636.
    27. Jane Hall & Richard De Abreu Lourenco & Rosalie Viney, 1999. "Carrots and sticks—the fall and fall of private health insurance in Australia," Health Economics, John Wiley & Sons, Ltd., vol. 8(8), pages 653-660, December.
    28. Kettlewell, Nathan & Zhang, Yuting, 2024. "Financial incentives and private health insurance demand on the extensive and intensive margins," Journal of Health Economics, Elsevier, vol. 94(C).
    29. Dominic Coey, 2015. "The Effect of Medicaid on Health Care Consumption of Young Adults," Health Economics, John Wiley & Sons, Ltd., vol. 24(5), pages 558-565, May.
    30. Cardella, Eric & Depew, Briggs, 2014. "The effect of health insurance coverage on the reported health of young adults," Economics Letters, Elsevier, vol. 124(3), pages 406-410.
    31. Denise Doiron & Nathan Kettlewell, 2020. "Family formation and the demand for health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 523-533, April.
    32. 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.
    33. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    34. Terence Chai Cheng & Anthony Scott & Sung‐Hee Jeon & Guyonne Kalb & John Humphreys & Catherine Joyce, 2012. "What Factors Influence The Earnings Of General Practitioners And Medical Specialists? Evidence From The Medicine In Australia: Balancing Employment And Life Survey," Health Economics, John Wiley & Sons, Ltd., vol. 21(11), pages 1300-1317, November.
    35. Jungtaek Lee, 2018. "Effects of health insurance coverage on risky behaviors," Health Economics, John Wiley & Sons, Ltd., vol. 27(4), pages 762-777, April.
    36. Terence C. Cheng & Alfons Palangkaraya & Jongsay Yong, 2014. "Hospital utilization in mixed public--private system: evidence from Australian hospital data," Applied Economics, Taylor & Francis Journals, vol. 46(8), pages 859-870, March.
    37. Buchmueller, Thomas C. & Fiebig, Denzil G. & Jones, Glenn & Savage, Elizabeth, 2013. "Preference heterogeneity and selection in private health insurance: The case of Australia," Journal of Health Economics, Elsevier, vol. 32(5), pages 757-767.
    38. Denise Doiron & Nathan Kettlewell, 2018. "The Effect of Health Insurance on the Substitution between Public and Private Hospital Care," The Economic Record, The Economic Society of Australia, vol. 94(305), pages 135-154, June.
    39. Judith Liu & Yuting Zhang, 2023. "Elderly responses to private health insurance incentives: Evidence from Australia," Health Economics, John Wiley & Sons, Ltd., vol. 32(12), pages 2730-2744, December.
    40. Ma, Yuanyuan & Nolan, Anne & Smith, James P., 2020. "Free GP care and psychological health: Quasi-experimental evidence from Ireland," Journal of Health Economics, Elsevier, vol. 72(C).
    41. Simona Laura Dragos & Codruta Mare & Cristian Mihai Dragos & Gabriela Mihaela Muresan & Alexandra-Anca Purcel, 2022. "Does voluntary health insurance improve health and longevity? Evidence from European OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1397-1411, November.
    42. Sarah Miller & Laura R. Wherry, 2019. "The Long-Term Effects of Early Life Medicaid Coverage," Journal of Human Resources, University of Wisconsin Press, vol. 54(3), pages 785-824.
    43. Shmueli, Amir & Savage, Elizabeth, 2014. "Private and public patients in public hospitals in Australia," Health Policy, Elsevier, vol. 115(2), pages 189-195.
    44. Cheng, Terence Chai, 2014. "Measuring the effects of reducing subsidies for private insurance on public expenditure for health care," Journal of Health Economics, Elsevier, vol. 33(C), pages 159-179.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Nicolas R. Ziebarth, 2018. "Social Insurance and Health," Contributions to Economic Analysis, in: Health Econometrics, volume 127, pages 57-84, Emerald Group Publishing Limited.
    2. Ha Trong Nguyen & Huong Thu Le & Luke Connelly & Francis Mitrou, 2023. "Accuracy of self‐reported private health insurance coverage," Health Economics, John Wiley & Sons, Ltd., vol. 32(12), pages 2709-2729, December.
    3. Andrey Aistov & Ekaterina Aleksandrova & Christopher J. Gerry, 2021. "Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(2), pages 281-309, March.
    4. Judith Liu & Yuting Zhang, 2023. "Elderly responses to private health insurance incentives: Evidence from Australia," Health Economics, John Wiley & Sons, Ltd., vol. 32(12), pages 2730-2744, December.
    5. Aparna Soni, 2020. "The effects of public health insurance on health behaviors: Evidence from the fifth year of Medicaid expansion," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1586-1605, December.
    6. Barbaresco, Silvia & Courtemanche, Charles J. & Qi, Yanling, 2015. "Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults," Journal of Health Economics, Elsevier, vol. 40(C), pages 54-68.
    7. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    8. Bernard Black & José-Antonio Espín-Sánchez & Eric French & Kate Litvak, 2017. "The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality," American Journal of Health Economics, University of Chicago Press, vol. 3(3), pages 281-311, Summer.
    9. Yörük Barış K., 2018. "Health insurance coverage and health care utilization: Evidence from the Affordable Care Act’s dependent coverage mandate," Forum for Health Economics & Policy, De Gruyter, vol. 21(2), pages 1-24, December.
    10. Raj Chetty & Amy Finkelstein, 2012. "Social Insurance: Connecting Theory to Data," NBER Working Papers 18433, National Bureau of Economic Research, Inc.
    11. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    12. Jungtaek Lee, 2018. "Effects of health insurance coverage on risky behaviors," Health Economics, John Wiley & Sons, Ltd., vol. 27(4), pages 762-777, April.
    13. Mengna Luan & Wenjing Shi & Zhigang Tao & Hongjie Yuan, 2023. "When patients have better insurance coverage in China: Provider incentives, costs, and quality of care," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(4), pages 1073-1106, October.
    14. Kondo, Ayako & Shigeoka, Hitoshi, 2013. "Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan," Journal of Public Economics, Elsevier, vol. 99(C), pages 1-23.
    15. Silvia Helena Barcellos & Mireille Jacobson, 2015. "The Effects of Medicare on Medical Expenditure Risk and Financial Strain," American Economic Journal: Economic Policy, American Economic Association, vol. 7(4), pages 41-70, November.
    16. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2019. "Effects of the Affordable Care Act on Health Behaviors After 3 Years," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 45(1), pages 7-33, January.
    17. Courtemanche, Charles & Marton, James & Ukert, Benjamin & Yelowitz, Aaron & Zapata, Daniela, 2018. "Effects of the Affordable Care Act on Health Behaviors after Three Years," IZA Discussion Papers 11468, Institute of Labor Economics (IZA).
    18. Tzu-Ting Yang & Hsing-Wen Han & Hsien-Ming Lien, 2014. "Patient Cost-Sharing and Healthcare Utilization in Early Childhood: Evidence from a Regression Discontinuity Design," Working Papers 14C003, Canadian Centre for Health Economics.
    19. Yörük Barış K., 2017. "Health Insurance Coverage and Risky Health Behaviors among Young Adults," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 17(3), pages 1-21, July.
    20. Fitzpatrick, Maria D. & Moore, Timothy J., 2018. "The mortality effects of retirement: Evidence from Social Security eligibility at age 62," Journal of Public Economics, Elsevier, vol. 157(C), pages 121-137.

    More about this item

    Keywords

    Private health insurance; Health; Mental health; Mandates;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:empeco:v:68:y:2025:i:4:d:10.1007_s00181-024-02680-2. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.