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Willingness-to-Pay for Parallel Private Health Insurance: Evidence from Laboratory Experiment


  • Neil Buckley

    () (Department of Economics, York University)

  • Katherine Cuff

    () (Department of Economics, McMaster University)

  • Jeremiah Hurley

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

  • Logan McLeod

    () (Department of Public Health Sciences, School of Public Health University of Alberta)

  • Robert Nuscheler

    () (Department of Economics, University of Augsburg)

  • David Cameron

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


Debate over the effects of public versus private health care financing has been, and continues to be, active in both academic outlets and policy circles. Theoretical literature on parallel health care financing is often built on untested behavioural assumptions and the empirical evidence generally depends upon the institutional details of the specific health care systems under analysis. This paper contributes to the literature on parallel health care finance by developing and executing a revealed preference laboratory experiment based on the theoretical model of parallel health care finance in Cuff et al. (2008). The theoretical model involves individuals in the labour force with varying severities of illness who demand health care from a limited supply of health care resources. Health care resources are purchased by the public sector and rationed free of charge to individuals, or purchased by individuals through a private insurance market. The general theoretical model is converted into a discrete experimental representation of a large-scale economy where individuals are price takers, the probability of receiving public health care is exogenous and the willingness-to-pay (WTP) for private health insurance is elicited from subjects. The experimental design includes two within-subject factors based on the theoretical model: the public sector rationing rule (rationing based on need or severity versus rationing based on a random allocation) and the probability of being publicly treated (high versus low). The experimental design also includes two between-subjects treatments based on the frame of the experiment (neutral frame versus health frame) and on the distribution of private health insurance prices (high prices versus low prices). The results show the public system's allocation rule and the probability of receiving health care from the public system both significantly affect an individual's WTP for private health insurance in the predicted direction, although the WTP values tend to be above the actual theoretical predictions. When the public system allocates health care based on need, the average WTP is lower than under random allocation. A higher probability of receiving health care from the public system elicits a lower WTP regardless of how the public system allocates health care. It is also found that when the public system allocates health care based on need, the WTPs are significantly higher under a neutral frame than a health frame.

Suggested Citation

  • Neil Buckley & Katherine Cuff & Jeremiah Hurley & Logan McLeod & Robert Nuscheler & David Cameron, 2010. "Willingness-to-Pay for Parallel Private Health Insurance: Evidence from Laboratory Experiment," Centre for Health Economics and Policy Analysis Working Paper Series 2010-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  • Handle: RePEc:hpa:wpaper:201002

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    References listed on IDEAS

    1. Aki Tsuchiya & Paul Dolan, 2009. "Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism," Health Economics, John Wiley & Sons, Ltd., vol. 18(2), pages 147-159.
    2. Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
    3. Karni, Edi & Safra, Zvi, 1987. ""Preference Reversal' and the Observability of Preferences by Experimental Methods," Econometrica, Econometric Society, vol. 55(3), pages 675-685, May.
    4. 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.
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    Cited by:

    1. Buckley, Neil J. & Cuff, Katherine & Hurley, Jeremiah & McLeod, Logan & Mestelman, Stuart & Cameron, David, 2012. "An experimental investigation of mixed systems of public and private health care finance," Journal of Economic Behavior & Organization, Elsevier, vol. 84(3), pages 713-729.
    2. Luba Petersen & Guidon Fenig, 2015. "Distributing scarce jobs and output: Experimental evidence on the effects of rationing," Discussion Papers dp15-02, Department of Economics, Simon Fraser University.
    3. Pfarr, Christian & Schmid, Andreas, 2013. "The political economics of social health insurance: the tricky case of individuals’ preferences," MPRA Paper 44534, University Library of Munich, Germany.
    4. Guidon Fenig & Mariya Mileva & Luba Petersen, 2013. "Asset Trading and Monetary Policy in Production Economies," Discussion Papers dp13-08, Department of Economics, Simon Fraser University, revised Aug 2014.
    5. Martina Grunow & Robert Nuscheler, 2014. "Public And Private Health Insurance In Germany: The Ignored Risk Selection Problem," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 670-687, June.
    6. Meliyanni Johar & Glenn Jones & Michael P. Keane & Elizabeth Savage & Olena Stavrunova, 2013. "The Demand for Private Health Insurance: Do Waiting Lists Matter?” – Revisited," Economics Papers 2013-W09, Economics Group, Nuffield College, University of Oxford.
    7. Andreas Richter & Jörg Schiller & Harris Schlesinger, 2014. "Behavioral insurance: Theory and experiments," Journal of Risk and Uncertainty, Springer, vol. 48(2), pages 85-96, April.
    8. repec:kap:expeco:v:20:y:2017:i:3:d:10.1007_s10683-016-9507-y is not listed on IDEAS
    9. Christian Pfarr & Andreas Schmid, 2016. "Redistribution through social health insurance: evidence on citizen preferences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(5), pages 611-628, June.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • C91 - Mathematical and Quantitative Methods - - Design of Experiments - - - Laboratory, Individual Behavior


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