A Comparative Policy Analysis of Private Financing for Diagnostic Services in 8 OECD Countries Between 1990 and 2010

Objectives

1. Analyze the interplay between public and private health insurance regulations for financing diagnostic services across 8 OECD countries between 1990 and 2010.
2. Assess how varying roles and regulatory regimes for private health insurance (PHI) potentially affect health inequalities.

 Methods

Policy data on the financing and provision of diagnostic services in Australia, Canada, England, Finland, France, Germany, Italy, and Portugal were extracted from the Health Insurance Access Database (HIAD), a dataset of policy indicators characterizing the relationship between public health insurance coverage and private expenditure regulations since 1990. The HIAD data were collected through focused literature reviews of legislative and academic sources. Data quality was verified using a multi-stage content review procedure. Key policy indicators of the legality and regulation of private service delivery between 1990 and 2010 were extracted and analyzed in a spreadsheet to facilitate interpretation.

Results

Private provision of diagnostic services was legal in all 8 countries between 1990 and 2010. A ban on purchasing PHI was only found in Australia where private services are financed out of the patient’s pocket. Among the remaining 8 countries, notable heterogeneity was found in the extent of private market regulation affecting access to care via: levels of coverage, types of PHI plans, regulations on premiums, limits on out-of-pocket payments, PHI enrolment, and PHI renewal. Policies ranged from extensive regulation of private markets in Finland, Germany and France to very minimal regulation in Canada and England.

Conclusion

Greater PHI regulation to counter inequitable financing and access to services, exists in health systems where it is widely used and an established means of covering the cost of care. Conversely, where PHI exists but plays a limited role, regulation is minimal. Our findings suggest the function and regulation of PHI over time are appropriate indicators to examine inequalities in health systems.