IDEAS home Printed from
   My bibliography  Save this article

Changes in the demand for private medical insurance following a shift in tax incentives


  • Marisol Rodriguez
  • Alexandrina Stoyanova


The 1998 Spanish reform of the Personal Income Tax eliminated the 15% deduction for private medical expenditures including payments on private health insurance (PHI) policies. To avoid an undesired increase in the demand for publicly funded health care, tax incentives to buy PHI were not completely removed but basically shifted from individual to group employer-paid policies. In a unique fiscal experiment, at the same time that the tax relief for individually purchased policies was abolished, the government provided for tax allowances on policies taken out through employment. Using a bivariate probit model on data from National Health Surveys, we estimate the impact of said reform on the demand for PHI and the changes occurred within it. Our findings indicate that the total probability of buying PHI was not significantly affected by the reform. Indeed, the fall in the demand for individual policies (by 10% between 1997 and 2001) was offset by an increase in the demand for group employer-paid ones. We also briefly discuss the welfare effects on the state budget, the industry and society at large. Copyright © 2007 John Wiley & Sons, Ltd.

Suggested Citation

  • Marisol Rodriguez & Alexandrina Stoyanova, 2008. "Changes in the demand for private medical insurance following a shift in tax incentives," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 185-202.
  • Handle: RePEc:wly:hlthec:v:17:y:2008:i:2:p:185-202 DOI: 10.1002/hec.1248

    Download full text from publisher

    File URL:
    File Function: Link to full text; subscription required
    Download Restriction: no

    References listed on IDEAS

    1. Propper, Carol, 1993. "Constrained choice sets in the U.K. demand for private medical insurance," Journal of Public Economics, Elsevier, vol. 51(3), pages 287-307, July.
    2. 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.
    3. Hansen, Bodil O. & Keiding, Hans, 2002. "Alternative health insurance schemes: a welfare comparison," Journal of Health Economics, Elsevier, vol. 21(5), pages 739-756, September.
    4. Danzon, Patricia M., 2002. "Welfare effects of supplementary insurance: a comment," Journal of Health Economics, Elsevier, vol. 21(5), pages 923-926, September.
    5. Beenstock, Michael & Rahav, Giora, 2002. "Testing Gateway Theory: do cigarette prices affect illicit drug use?," Journal of Health Economics, Elsevier, vol. 21(4), pages 679-698, July.
    6. Jonathan Gruber & James M. Poterba, 1993. "Tax Incentives and the Decision to Purchase Health Insurance: Evidence from the Self-Employed," NBER Working Papers 4435, National Bureau of Economic Research, Inc.
    7. 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.
    8. Carol Propper, 1987. "An econometric estimation of the demand for private health insurance," Working Papers 024chedp, Centre for Health Economics, University of York.
    9. Besley, Timothy & Hall, John & Preston, Ian, 1999. "The demand for private health insurance: do waiting lists matter?," Journal of Public Economics, Elsevier, vol. 72(2), pages 155-181, May.
    10. Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
    11. Propper, Carol & Rees, Hedley & Green, Katherine, 2001. "The Demand for Private Medical Insurance in the UK: A Cohort Analysis," Economic Journal, Royal Economic Society, vol. 111(471), pages 180-200, May.
    12. Jonathan Gruber & Michael Lettau, 2000. "How Elastic is the Firm's Demand for Health Insurance?," NBER Working Papers 8021, National Bureau of Economic Research, Inc.
    13. Hoel, Michael & Saether, Erik Magnus, 2003. "Public health care with waiting time: the role of supplementary private health care," Journal of Health Economics, Elsevier, vol. 22(4), pages 599-616, July.
    14. Gruber, Jonathan & Lettau, Michael, 2004. "How elastic is the firm's demand for health insurance?," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1273-1293, July.
    15. Johannesson, Magnus & Johansson, Per-Olov & Soderqvist, Tore, 1998. "Time spent on waiting lists for medical care: an insurance approach," Journal of Health Economics, Elsevier, vol. 17(5), pages 627-644, October.
    16. 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.
    17. Epple, Dennis & Romano, Richard E, 1996. "Public Provision of Private Goods," Journal of Political Economy, University of Chicago Press, vol. 104(1), pages 57-84, February.
    18. Miguel Gouveia, 1996. "The public sector and health care," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 3(3), pages 329-349, July.
    19. Gertler, Paul & Sturm, Roland, 1997. "Private health insurance and public expenditures in Jamaica," Journal of Econometrics, Elsevier, vol. 77(1), pages 237-257, March.
    20. Van de Ven, Wynand P. M. M. & Van Praag, Bernard M. S., 1981. "The demand for deductibles in private health insurance : A probit model with sample selection," Journal of Econometrics, Elsevier, vol. 17(2), pages 229-252, November.
    21. Joan Costa & Jaume Garcia, 2003. "Demand for private health insurance: how important is the quality gap?," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 587-599.
    22. Colm Harmon & Brian Nolan, 2001. "Health insurance and health services utilization in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 135-145.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Astrid Kiil, 2012. "Does employment-based private health insurance increase the use of covered health care services? A matching estimator approach," International Journal of Health Economics and Management, Springer, vol. 12(1), pages 1-38, March.
    2. Kiil, Astrid, 2012. "What characterises the privately insured in universal health care systems? A review of the empirical evidence," Health Policy, Elsevier, vol. 106(1), pages 60-75.
    3. Waleska Sigüernza & Petr Mariel, 2013. "Valoración económica de los servicios sanitarios en la Comunidad Autónoma del País Vasco," Hacienda Pública Española, IEF, vol. 207(4), pages 71-99, December.
    4. 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.
    5. López Nicolás, Ángel & Vera-Hernández, Marcos, 2008. "Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model," Journal of Health Economics, Elsevier, vol. 27(5), pages 1285-1298, September.
    6. Jesús Clemente López & Pedro García Castrillo & María A. González Alvarez & Marcos Sanso Frago, 2014. "Una evaluación de la efectividad de la formación ocupacional para desempleados antes y después de la crisis económica: el caso de Aragón," Hacienda Pública Española, IEF, vol. 208(1), pages 77-106, March.

    More about this item


    Access and download statistics


    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:wly:hlthec:v:17:y:2008:i:2:p:185-202. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley-Blackwell Digital Licensing) or (Christopher F. Baum). General contact details of provider: .

    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 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.