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11 Regulating Private Health Insurance Markets jürgen wasem and stefan greß Compared to other sources of health care finance, private health insur- ance (PHI) is of minor importance in Western Eu rope and Canada. On aver- age, private health insurance contributes less than 10 percent to health expenditures in these countries. However, PHI played a relatively significant role in the Netherlands (15 percent), Canada (11 percent) and Germany (13 percent) in 2000 (Colombo and Tapay 2004).1 Within the OECD, it is only in the United States that PHI accounts for more

P R I V A T E H E A L T H I N S U R A N C E : P R O G R E S S A N D P R O B L E M S Herman M. Somers H o w odd it now seems that only three decades ago private health insurance was highly controversial and attacked as a restraint on personal liberty and the unfettered practice of medicine. Its initial acceptance by the medical profession was a lesser evil compared to the threat of public health insurance, but the high status it has achieved since then is a product of spectacular success. Health insurance grew more rapidly than even its most en

Preserving Privilege, Promoting Profit: The Payoffs from Private Health Insurance ROBERT G. EVANS A majority of the Supreme Court of Canada in the Chaoulli decision were convinced that the ability to access private health insurance would result in ‘many’ Quebeckers being able to avoid unnecessary pain and suffering resulting from long waiting times in publicly-funded Medi- care. In this paper, I review the extent to which private insurance is a prevalent form of financing around the world. I argue that private health insurance plays a minimal role worldwide in

2 Bargaining for Health: Private Health Insurance and Public Policy AS a political alternative to national health insurance, private insurancehad enormous appeal to a wide range of interests. As a practical alternative, it was a dismal failure—leaving public policy to subsidize pri- vate plans, mop up around their edges, and (in the process) stigmatize those they left behind. In turn, private coverage proved inherently frag- mentary and discriminatory: it magnified the impact of job segregation by race and gender, perpetuated the ideal of family-wage male employ

278 Access to Care, Access to Justice The Role of Private Health Insurance in Social Health Insurance Countries – Implications for Canada STEFAN GREß 1 Introduction Private health insurance serves three distinct functions in Western Eu- ropean social health insurance systems.1 The first is as an alternative for mandatory (statutory) social health insurance arrangements. In Ger- many, a part of the population may chose between joining private health insurance and remaining in social health insurance. The second function is to supplement basic health insurance

234 What Is Crowd-Out? Historically, high numbers of individuals without health insurance have meant that the United States must deliver care to roughly 15 percent of the popula- tion through a fragmented health care safety net that includes Medicaid, fed- erally qualified health centers, and a variety of sources of free care, such as free clinics (Department of Health and Human Services 2005). The severe economic downturn that began in 2007 and resulted in record high unemployment, combined with a private health insurance sector that is dominated by employer

; Sauerland et al. 2009 ; Schwierz et al. 2011 ; Roll et al. 2012 ). More precisely, there is an increasing concern in Germany about discrimination in access to medical care by insurance type (e. g. Lungen et al. 2008 ; Roll et al. 2012 ). The German health insurance system consists of two key components: the Statutory Health Insurance (SHI) and the Private Health Insurance (PHI). There are financial benefits for physicians to treat private patients which provide strong incentives to offer preferential treatment for PHI compared to SHI policy holders. For example

(become more negative) over time. KEYWORDS: private health insurance, female labor supply ∗The author thanks Thomas Buchmueller, Todd Elder, Peter Feuille, Kevin Hallock, Helen Levy, Darren Lubotsky, Craig Olson, and an anonymous reviewer for helpful comments and suggestions on earlier drafts. Approximately 65 percent of the non-elderly population and 70 to 75 of the working non-elderly population of adults are covered by employer provided health insurance in the United States (Fronstin, 2008). Married individuals are significantly more likely to have employer

people to move within the systems and between the two systems. The fact that only civil servants, the self-employed and high-earners may insure themselves privately no longer can be historically explained. An increasing number of insured see contributions to private health insurances rise dramatically and they cannot afford to pay them anymore. Therefore, the question of the future of private health insurances is primarily a socio-political issue. Each insured person must be entitled to an affordable access to a health insur- ance, whether public or private

-1- The Economists’ Voice December, 2010© Berkeley Electronic Press The Economics, Opportunities, and Challenges of Health Insurance Exchanges MARK DUGGAN AND BOB KOCHER A central component of the Af- fordable Care Act (ACA) is the creation of state-based health insurance exchanges, which have the potential to substantially im- prove the functioning and expand the reach of the private health insurance market. Here, we describe salient features of the current mar- ket for health insurance and explain how the exchanges will build on this system by alter