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Buying the Exit Option: Private Insurance in a Universal Health System -Evidence from Portugal, 2005-2019

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  • de Mello-Sampayo; F.;

Abstract

This paper documents a near-tripling of voluntary private health insurance coverage in Portugal across three national health surveys and argues, using complementary empirical strategies, that this expansion reflects exit -option demand from a rationed public system rather than conventional risk pooling. The income gap in coverage widened during the 2010-2014 austerity shock and partially unwound during recovery. An Oaxaca-Blinder decomposition attributes roughly 89 percent of the 2005-2014 expansion to behavioural change, while a triple-difference design provides directionally consistent evidence that high-need, high-income individuals drove the austerity-period growth. The findings have direct implications for the design of universal health systems that accommodate supplementary private coverage.

Suggested Citation

  • de Mello-Sampayo; F.;, 2026. "Buying the Exit Option: Private Insurance in a Universal Health System -Evidence from Portugal, 2005-2019," Health, Econometrics and Data Group (HEDG) Working Papers 26/08, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:26/08
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    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis

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