Analysis of the development of voluntary health insurance in OECD countries

Balynin Igor' Viktorovich PhD in Economics Associate Professor, Department of Public Finance, Faculty of Finance, Financial University under the Government of the Russian Federation 125468, Russia, Moscow, Leningradsky ave., 49 igorbalynin@mail.ru Other publications by this author

The relevance of the study of issues related to the development of the health system is beyond doubt, because it meets the national interests of all countries, including in the context of achieving the Sustainable Development Goals defined by the UN General Assembly. These issues become particularly relevant for Russian social policy in the context of achieving the national development goals of the Russian Federation, defined by the Decree of the President of Russia dated July 21, 2020.

The purpose of the study is to determine the trends and parameters of the development of voluntary health insurance in the OECD countries.

Research methodology. Within the framework of this scientific research, methods of data analysis and synthesis, their grouping and graphical interpretation were used.

Review of literary sources. The analysis of domestic and foreign scientific literature will allow us to conclude that in recent years scientists have taken a trend to study the implementation of responsible budget policy ^[7,12,13], suggesting the importance of improving the quality of life of the population ^{[3, 6]}. In particular, the latter is considered in scientific articles and from the position of the administrator of the health management system ^[2]. The authors also consider issues related to gender ^[4] and regional differentiation ^[1] in the field of healthcare. It is obvious that in different regions of the Russian Federation, the volumes of financial support for the healthcare system differ.  This requires the formation of the concept of regulation of socio-economic inequality of households ^[5].

In the context of the need to provide solutions to health problems that have increased during the pandemic, and at the same time a limited amount of financial resources, the task of finding alternative financial options for providing free medical care to citizens arises. One of such options is voluntary medical insurance, which is not given sufficient attention in comprehensive scientific works on the modernization of the health care system ^[10,11,14]. Therefore, the authors rightly note the importance of stimulating its development ^[8], which undoubtedly requires administrative and legal regulation ^[9].

In the foreign scientific literature, the experience of the OECD countries in terms of the development of the healthcare system is actively studied both individually ^[16,17,19] and comprehensively ^[18]. However, the assessment of the development of voluntary health insurance in these countries has not been carried out, although, presumably, this can act as a strong driver of life expectancy growth. Therefore, we consider it important to study the experience of the OECD countries, which will later become a good methodological basis for improving the healthcare system in the Russian Federation in the context of achieving the national development goals of our state, defined by the President of Russia in July 2020.

The results of the study. Non-state medical insurance can be divided into mandatory and voluntary. It is important to note that compulsory private health insurance is most developed in 7 countries (the Netherlands, Switzerland, the USA, Chile, Germany, France, Colombia), in which it is often associated with covering the costs of providing basic services, not additional ones (for example, in the Netherlands about 60% of all health care costs account for for the expenses of private insurers). The experience of Colombia is quite interesting, where the costs of compulsory private health insurance relate to the obligations of private insurers to cover medical expenses arising from road accidents or industrial accidents ^[20].

In turn, voluntary health insurance exists in almost all countries. Thus, the analysis of the development of voluntary health insurance in the OECD countries was carried out. In particular, Figure 1 shows the ratio of voluntary health insurance funds to gross domestic product in OECD countries.  As we can see, the highest values of this indicator were found in Canada (1.7%), Australia (1.4%) and Slovenia (1.3%).

To distribute countries by the level of development of voluntary health insurance, we will combine them into 5 groups: with a high level of development, with a level of development above average, with an average level of development, with a level of development below average, with a low level of development. To do this, we will calculate the ratio of the considered indicator for each country to the data for the state with the highest value (Canada is such). The results of the distribution by country will depend on the results obtained. High: received value ? (0.8–1], above average: received value ? (0.6–0.8], average: received value ? (0.4–0.6], below average: received value ? (0.2–0.4], low: received value ? below 0.2.

Figure 1. The ratio of voluntary health insurance funds to gross domestic product, 2019, in %.

Source: built by the author according to OECD data ^[21]

Table 1 presents the results of the assessment of the level of development of voluntary health insurance in OECD countries in accordance with the grouping approach described above.

Table 1 – Results of a comparative assessment of the level of development of voluntary health insurance in OECD countries

Source: constructed and calculated by the author on the basis of OECD data.

It is important to note that countries with a high level of voluntary health insurance coverage include: Australia (54%), Canada (68%), Ireland (47%), Slovenia (89.8%) ^[22]. Due to the specifics of the risks covered under compulsory medical insurance, voluntary medical insurance can be used to cover certain risks (for example, in the Netherlands for dental medical care ^[23], and in Canada for the purchase of pharmaceuticals ^[24]).

Discussion of the results of the study. In the OECD reports "Health at a Glance" it is noted that the key indicator of the general health of the population is life expectancy ^[23]. In order to determine possible constraining factors for the development of voluntary health insurance in OECD countries, the correlation of the results obtained with such indicators as the Human development Index (hereinafter – HDI), GDP per capita in US dollars (hereinafter – HDI), coefficient (hereinafter – Jinni) was carried out.

Table 2 presents the results of the assessment of socio-economic indicators of OECD countries with average and higher levels of development of voluntary health insurance

Table 2 – Assessment of socio-economic indicators of OECD countries with average and higher levels of development of voluntary health insurance

Symbols: URDMS – the level of development of voluntary medical insurance.

Sources: constructed by the author on the basis of data from the OECD and the World Bank.

Table 3 shows the results of the assessment of socio-economic indicators of OECD countries with below average and low levels of development of voluntary health insurance.

Table 3 – Assessment of socio-economic indicators of OECD countries with below-average and low levels of voluntary health insurance development

Symbols: URDMS – the level of development of voluntary medical insurance.

Sources: constructed by the author on the basis of data from the OECD and the World Bank.

Analysis of the data in Tables 2 and 3 allows us to conclude that All countries, except Mexico and Colombia, have a high level of the human development index. In countries with a high level of development of voluntary health insurance, life expectancy is 83 years, in Slovenia – 81 years (the only country in the group above average). In turn, the average value of this indicator for countries with an average level is 80.42 years, below average – 79.14 years, low – 78.62 years. Based on this, it seems possible to conclude that the increase in the level of development of voluntary health insurance increases life expectancy.

Based on the results of the study, we conclude that in the OECD countries, the degree of distribution of voluntary health insurance is heterogeneous, but it is an integral element of the system of medical care for citizens. It would be useful to disseminate this experience in the Russian practice of medical care, which would make a positive contribution to the achievement of the national development goals of the Russian Federation for the period up to 2030.

The article is based on the results of research carried out at the expense of budgetary funds under the state assignment of the Financial University under the Government of the Russian Federation.