Voluntary Health Insurance in the european union

Voluntary Health Insurance in the european union by Elias Mossialos and Sarah Thomson

This study provides an overview of markets for voluntary health insurance (VHI)1 in the European Union (EU). It examines their role in providing access to health care; assesses their impact on the free movement of people and services; and analyses recent trends and future challenges for voluntary health insurers and policy-makers at national and EU levels. VHI markets in the European Union are diverse. This diversity arises from different historical patterns of development, variations in the rules and arrangements of statutory health care systems and discrepancies in national regulatory regimes. These factors underlie the wide range of: types of VHI on offer, levels of expenditure on VHI, levels of population coverage, types of insurer, mechanisms for premium-setting, selection criteria, policy conditions, benefits provided, premium prices, tax incentives, loss ratios, administrative costs, levels of access, equity implications and impact on free movement. The types of VHI on offer in a particular member state reflect both the historical development and the current rules and arrangements of that member state’s statutory health care system. Public policy in EU member states has aimed to preserve the principle of health care funded by the state or social insurance and made available to all citizens, regardless of ability to pay. As a result, statutory health care systems in the European Union are broadly characterized by near-universal coverage, mandatory participation, the provision of comprehensive benefits and high levels of public expenditure. These characteristics have been important determinants of the scope and size of VHI markets in the European Union, and the voluntary nature of such markets means that they generally operate in areas that the state does not cover. In the EU context, therefore, we classify VHI according to whether it:

• substitutes for cover that would otherwise be available from the state (substitutive VHI); 
• provides complementary cover for services excluded or not fully covered by the state, including cover for co-payments imposed by the statutory health care system (complementary VHI); or 
• provides supplementary cover for faster access and increased consumer choice (supplementary VHI)

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