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Session: Complementary Insurance
Room: Meeting Rooms 25+26
Time: Thu 14:30-15:45

Presenter: Sophie Guthmuller (Paris Dauphine University. Laboratory for Health Economics and Management of Health Administrations (LEGOS))

Abstract

Inequalities in access to health care are well documented in France. They are mainly explained by inequalities in access to complementary health insurance. Even if the poorest 7% of French residents are covered for most of the out-of-pocket payments by the "free complementary health insurance plan" (Couverture maladie universelle complémentaire, CMUC) since 2000, 8% of the French population remains without any complementary health insurance and this proportion is higher among households whose resources are just above the CMU eligibility threshold.
In order to improve financial access to complementary health insurance and reduce the threshold effect induced by the CMUC, a complementary health insurance voucher has been introduced in 2005 for this specific population. Despite a regular increase in uptake, four years after being set up the system concerned only a little over 490,000 people. This result is far below the 2 million people initially targeted.
Several hypotheses can explain this evidence : 1. unaffordability of health insurance despite this financial aid, considering that beneficiaries have to pay almost 50% of the price of the contract after the voucher ; 2. lack of information on the take-up administrative process ; 3. voluntary trade-off between private consumption and health coverage.

In order to evaluate these different hypotheses, we develop an experiment with the National Health Insurance Fund. Three groups of 1680 eligible households living in urban area in North of France have been randomly selected: a control group benefiting of the current financial aid, a group benefiting of a 50% voucher increase, and a last group benefiting of a 50% voucher increase and a social take-up support. The three groups have been followed-up during 6 months to observe their health insurance purchase.
The comparison of the health coverage rate among the three groups will provide some indications on the respective effects of financial incentives and informal barriers on health insurance demand.

The experimental data will then be merged with administrative data from the Public Health Insurance Fund to have information on income, supports received, health expenditures of the 2 previous years and health insurance status. A survey is also being conducted among the 3 groups and among a subsample of individuals which previously benefit from the ACS to explore: 1. the determinants of their health insurance status, 2. the determinants of ACS adherence. Finally, the health insurance purchase and the health expenditures will be followed during one year to explore the efficacy of the experiment.

Findings from this study will enhance the understanding of the determinants of health insurance demand among the poorest population and help design better public policies to promote access of the poor to health insurance in order to tackle horizontal inequity in access to health care.

Key Terms

Demand for Complementary Health Insurance, Acces to Health Care, Public Policy, Social Experiment, Low-income population, France

Authors:

Sophie Guthmuller (Paris Dauphine University. Laboratory for Health Economics and Management of Health Administrations (LEGOS)) , Florence Jusot (Paris Dauphine University / Institute fo research and information in Health Economics (IRDES). Laboratory for Health Economics and Management of Health Administrations (LEGOS) and Jérôme Wittwer (Paris Dauphine University. Laboratory for Health Economics and Management of Health Administrations (LEGOS))

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