The Effect of Private Health Insurance Coverage on Health Services Utilisation
in New Zealand
Prepared by Linda J. Blumberg, PhD | July 2006 with funding from the sponsors
of the Ian Axford New Zealand Fellowships in Public Policy
Linda Blumberg is a Principal Research Associate
at the Urban Institute in Washington, DC, where she has worked since
1992. From 1993 to 1994, she served as health policy advisor to
the Clinton Administration during its initial health care reform
effort. In her research, Linda has focused on issues of health care
policy and economics. Her recent work includes a variety of projects
related to private health insurance and health care financing.
During Linda's Ian Axford Fellowship in New Zealand, she was based
at Victoria University of Wellington's Health Services Research
Centre and the Ministry of Health. Her research focused on the interactions
between public and private health insurance coverage, specifically
the impact of private health insurance on the use of publicly financed
services.
Abstract
Private health insurance can lead to interactive effects with the public
health system. It is possible that care delivered under private insurance
is not replacing public spending, but increasing total national spending
on health care. And because comprehensive policies lower the out-of-pocket
price for obtaining public services, this type of coverage may increase
the use of those services, thereby increasing public spending. This study
assesses the impact of private health insurance coverage on the use of
health services in New Zealand, using 2002/2003 New Zealand Health Survey
data.
This analysis indicates significant interactive effects between private
insurance and the use of health services. These effects are particularly
pronounced with regard to care received outside of the hospital setting.
Private insurance tends to increase the use of GP services, specialist
services, and pharmaceuticals among those most likely to have comprehensive
health insurance - high-income individuals. There is no overall significant
effect of private insurance on public hospital inpatient, daypatient,
or emergency room care. If private in-patient care acts as a substitute
for public in-patient care, one would expect significant overall declines
in public in-patient use associated with having private coverage. These
findings contradict arguments supporting a tax rebate for the purchase
of private insurance.
Table
of contents
Acknowledgments
Executive Summary
Introduction
Review of Literature
Data and Methods
Descriptive Analysis of Individuals With and Without Private Health
Insurance
Multivariate Analyses: The Effect of Private Insurance Coverage on
the Utilisation of Health Services
axford2006_blumberg.pdf (339kb)
