Voluntary Health Insurance in the European Union
Spending on voluntary health insurance (VHI) as a proportion of total expenditure on health care is in the EU low (in 1998 less than 10% of total expenditure in every member state except France (12.2%) and the Netherlands (17.7%)). The high price of VHI premiums in some member states (particularly for individual policies), the absence of open enrolment, lifetime cover and community rating, and the imposition of stringent selection criteria and policy conditions present barriers to VHI for those on low incomes, people with pre-existing conditions, elderly people and people without employment. Risk selection, which may raise concerns about inequalities in access to health care, is likely to occur where voluntary health insurers are able to reject applications, exclude pre-existing conditions and cancel contracts. The existence of VHI could present a barrier to access in the statutory health care system for some individuals and population groups if it creates distortions in the allocation of resources (e.g. if capacity is limited, if providers are paid by both the public and the private sector and if VHI creates incentives for health care professionals to treat public and private patients differently). Any expansion of VHI markets in future is likely to depend on developments in statutory health care systems. It does not follow that expanding VHI will automatically result in reduced levels of public spending on health care or increased levels of coverage. Three options open to EU policy-makers might influence the future expansion of VHI markets: allowing more individuals to opt out of the statutory health care system, further excluding specific health services from statutory cover (either explicitly or through non-explicit rationing) and introducing or increasing tax incentives to purchase VHI.
