Somebody get me a doctor: Voluntary health insurance, social background and subjective health in Europe, 2002–2022

BACKGROUND: The last couple of decades have seen a steady increase in the uptake of voluntary health insurance (VHI) across Europe. So far, very little is known about the impact of VHI on the health of the population and the possible inequalities in health. OBJECTIVE: We examined the relationship between VHI in European countries and the subjective health of its citizens in the period 2002-22, and whether this is contingent upon a person's social background METHODS: We combined the most recent data available on VHI with individual data on subjective health and socio-economic background from the European Social Survey RESULTS: Within-country increases in VHI was associated with poorer health in the population in the long term. Furthermore, individuals with low education had a higher probability of reporting poor health if they live in a country where VHI increased during the period. Our results thus lend no support to the so-called 'substitution argument', which hypothesises that VHI may redistribute resources from the better-off and ease the burden of the public healthcare system. Instead, the results indicate a 'crowding out'-effect, whereby VHI crowd out resources from the public system, resulting in poorer quality of public health services and thereby negative health effects for those remaining in the public sector. CONCLUSION: European health policy makers should develop strategies to minimize the potential adjacent side effects of VHI.