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Does free supplementary health insurance help the poor to access health care? Evidence from France


  • Michel Grignon

    () (Department of Economics, Centre for Gerontological Studies, Centre for Health Economics and Policy Analysis, McMaster University)

  • Marc Perronnin

    (Institut de recherche et de documentation en économie de la santé (IRDES), Paris, France)

  • John N. Lavis

    (Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, Department of Political Science, McMaster University)


The French government introduced a "free supplementary health insurance plan" in 2000, which covers most of the out-of-pocket payments faced by the poorest 10% of French residents. This plan was designed to help the non-elderly poor to access health care. To assess the impact of the introduction of the plan on its beneficiaries, we use a longitudinal dataset to compare, for the same individual, the evolution of his/her expenditures before and after enrolment in the plan. This longitudinal analysis allows us to remove most of the spuriousness due to individual heterogeneity, and we also use information on past coverage to evaluate the impact of specific benefits associated with the plan. As a result, we can properly assess the impact of the plan on those who enrolled in it. However, we cannot assess the impact of the plan on all of those who were eligible to enrol. Our main result is the plan’s lack of an overall effect on utilization. This result is likely attributable to the fact that those who were enrolled automatically in the free plan (the majority of enrollees), already benefited from a relatively generous plan. The significant effect among those who enrolled voluntarily in the free plan was likely driven by those with no previous supplemental coverage.

Suggested Citation

  • Michel Grignon & Marc Perronnin & John N. Lavis, 2006. "Does free supplementary health insurance help the poor to access health care? Evidence from France," Centre for Health Economics and Policy Analysis Working Paper Series 2006-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  • Handle: RePEc:hpa:wpaper:200602

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    More about this item


    health care financing; equity and inequalities; health care systems; health insurance; natural experiment;

    JEL classification:

    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs


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