Regulation of Private Expenditures in Cross-National Perspective

Over the past decade, health spending in many developed countries has grown faster than gross domestic product, leading governments to search for alternative financing structures, notably through increases in the share of private expenditures. However, as these increases are generally not randomly distributed in the population, these transformations have raised concerns about their impact on both population health and social inequalities in health. Finally, as the extent of private expenditures on health varies between developed countries, it appears that certain countries are better able to limit barriers to health insurance coverage, notably through more generous public coverage as well as greater governmental regulation of the private insurance industry.

This paper will examine this hypothesis with the Health Insurance Access Database (HIAD), by demonstrating the variation over time, by health service and across countries in the nature of those policies. The HIAD is a repository of policy indicators offering harmonized policy data on public coverage and the regulation of private expenditures. The standardization process used for collecting these indicators allows for comparisons over time (from 1990 to 2010), across health services (data are collected on 8 health services, for instance prescription drugs), and across 10 countries of the OECD (Australia, Canada, Denmark, Finland, France, Germany, Italy, the Netherlands, United Kingdom, and United States). These countries were selected to provide a range of variation (and thus to allow for contrasts) with regards to Esping Andersen’s Welfare Regime classification (Liberal, Social Democratic, Conservative), Roemer’s type of health system (comprehensive, welfare oriented, entrepreneurial) and the OECD’s typology of the role of PHI within that system (primary, primary substitutive, supplementary, duplicative or complementary).

This research will inform and feed the current debate on the future of health care in developed countries and on the interplay between the public and private sectors in these changes.