Incentives for voluntary health insurance in a national health system: Evidence from Italy |
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Authors: | Anna Marenzi Dino Rizzi Michele Zanette |
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Affiliation: | 1. Centre for Health Economics, University of York, Heslington, York YO10 5DD, United Kingdom;2. Institut des Politiques Publiques, Paris School of Economics, 48 boulevard Jourdan, 75014, Paris, France;3. Université Paris 1, Paris School of Economics, Hospinnomics, Hôtel-Dieu, 1 Parvis Notre Dame, 75004 Paris, France;1. Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, P.O Box 564, 751 22 Uppsala, Sweden;2. Forensic Medicine, Department of Surgical Sciences Uppsala University, Uppsala, Sweden;1. VIVE – The Danish Center for Social Science Research, Herluf Trolles Gade 11, København K, DK;2. Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, SW7 2A London, UK;3. Danish Centre for Health Economics, University of Southern Denmark, J.B. Winsløws Vej 9B, Odense C, DK;4. Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, DK |
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Abstract: | ObjectivesThe paper evaluates the extent to which the government's policy to encourage the purchase of voluntary health insurance (VHI) may have led to income-related horizontal inequity in access to health care in a universal health care system (NHS).MethodsAd hoc tax return data for the universe of Italian taxpayers for years 2009-2016 are used to estimate the tax benefits granted to taxpayers who hold VHI, the redistributive impact, and the public budget effect. The income elasticity of tax benefits is estimated using tax return data and considering some taxpayers’ characteristics (income class, gender, age, and geographic area). Standard inequality indices are computed to assess income-related horizontal inequity in access to health care.ResultsTax incentives, especially those granted to employer-paid health insurance, have a sizeable impact on tax revenue and introduce into the Italian NHS significant income-related horizontal and vertical inequity in access to health care. The results suggest a distributional profile of tax incentives that is highly concentrated in favor of wealthier taxpayers.ConclusionOur analysis adds novel evidence that may contribute to the current debate on whether and to what extent countries in which all citizens have access to free healthcare and equal standards of healthcare services should subsidize VHI, especially when the coverage doubles the healthcare services provided by universal public insurance. We show that VHI reduces tax revenues and introduces disparities among citizens in terms of access to healthcare services. |
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