Research Article

Supplemental health insurance and equality of access in Belgium

  1. Erik Schokkaert1,2,*,
  2. Tom Van Ourti3,4,
  3. Diana De Graeve5,
  4. Ann Lecluyse5,
  5. Carine Van de Voorde6

Article first published online: 7 APR 2009

DOI: 10.1002/hec.1478

Issue

Health Economics

Health Economics

Volume 19, Issue 4, pages 377–395, April 2010

Additional Information

How to Cite

Schokkaert, E., Van Ourti, T., De Graeve, D., Lecluyse, A. and Van de Voorde, C. (2010), Supplemental health insurance and equality of access in Belgium. Health Economics, 19: 377–395. doi: 10.1002/hec.1478

Author Information

  1. 1

    Department of Economics, KULeuven, Leuven, Belgium

  2. 2

    CORE, Université Catholique de Louvain, Belgium

  3. 3

    Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands

  4. 4

    Tinbergen Institute, Rotterdam, The Netherlands

  5. 5

    Faculty of Applied Economics, University of Antwerp, Antwerp, Belgium

  6. 6

    Belgian Health Care Knowledge Centre, Brussels, Belgium

*Department of Economics, KULeuven, Naamsestraat 69, B 3000 Leuven, Belgium.

Publication History

  1. Issue published online: 10 MAR 2010
  2. Article first published online: 7 APR 2009
  3. Manuscript Accepted: 12 FEB 2009
  4. Manuscript Revised: 2 FEB 2009
  5. Manuscript Received: 19 SEP 2007

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Keywords:

  • supplemental insurance;
  • adverse selection;
  • moral hazard;
  • hospital spells;
  • equality of access;
  • healthcare use

Abstract

The effects of supplemental health insurance on health-care consumption crucially depend on specific institutional features of the health-care system. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. Within this institutional background, we find only weak evidence of adverse selection in the coverage of supplemental health insurance. We find much stronger effects of socio-economic background. We estimate a bivariate probit model and cannot reject the assumption of exogeneity of insurance availability for the explanation of health-care use. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights per spell. We comment on the implications of our findings for equality of access to health care in Belgium. Copyright © 2009 John Wiley & Sons, Ltd.

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