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Governments in several OECD countries have used or considered using private health insurance (PHI) as a policy lever to promote certain health system goals, such as reducing financing pressures on public health systems, promoting individual choice and improving efficiency. Policy expectations for PHI, the size of PHI markets, and their impact on health systems, vary to a great extent across OECD members.
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This chapter provides an introduction to this report. It explains why OECD has undertaken a study on private health insurance, and the policy relevance of the analysis. It also illustrates the analytical framework underpinning all chapters. This framework applies both to the review of private health insurance markets, and to the analysis of their impact on health system performance. The chapter also describes the methodology adopted, as well as the sources of information that were gathered. It finally explains how the report is structured.
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This chapter describes the heterogeneity of experiences with private health insurance across OECD countries, and identifies clusters of countries where PHI presents common features and factors explaining differences in PHI markets across OECD countries. In particular, this chapter addresses the following questions: What is private health insurance? What roles does PHI play within the health financing systems of OECD countries? What are the characteristics of PHI markets...
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In comparing OECD countries’ experiences with different regulatory approaches, this chapter examines the contribution of certain regulatory structures and provisions to the achievement of key goals of health system performance, namely: equity, efficiency, choice and innovation, responsiveness and quality of care. The impact of such regulation is reviewed, however, predominantly for case study countries.
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This chapter aims to: 1) assess the impact of PHI on health systems and their performance; 2) identify the factors explaining the variation in performance across different systems of financing health care and across PHI markets. It does this by seeking answers to the following questions: How does PHI affect access to health services and timely care across people with different levels and types of health insurance coverage? What is PHI’s influence on the equity of health financing? What is PHI’s role in health system choice of provider and benefits? Do private insurers have a role in promoting innovation in health care and, if so, how? Have insurers implemented activities to improve health care quality? How does PHI affect health system expenditure? What implications does PHI have for health system cost-efficiency?
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This final chapter summarises the main findings of this report. It focuses, in particular, upon policy lessons arising from the analysis of the impact of private health insurance on health system, including policy objectives such as equity and access, responsiveness and choice, quality of care, cost control and cost efficiency. This chapter also highlights useful practices that can help policy makers ensure that PHI markets make a positive contribution to the performance of health systems.
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