Duplicate coverage and demand for health care. The case of Catalonia

TLDR

Duplicate coverage occurs when an individual holds both compulsory public insurance and a private plan. The study examines how duplicate coverage affects specialist visit demand and the private insurance market’s selection process. The authors use generalized method of moments econometric models that account for endogeneity in insurance choice and the non‑negative number of specialist visits, selecting instruments based on a theoretical demand model. The analysis finds that endogeneity matters for household heads but not for non‑heads, that duplicate coverage increases specialist visits among non‑heads, and that health, education, and income drive insurance choice, with heads purchasing private plans mainly due to poorer unobservable health linked to compulsory public coverage.

Abstract

An individual has duplicate coverage when he enjoys a compulsory medical public insurance, and in addition he has purchased a private one. This paper studies the implications of duplicate coverage on both demand for visits to specialists and on the selection process of the private insurance market. Econometric models, estimated by the generalized method of moments, accommodate both the endogeneity of insurance choice decision and the non-negativity of the variable number of visits. The choice of instrumental variables is motivated within a theoretical model of demand for health care. The results shows that endogeneity is important for the subsample of heads of household, but not for the subsample of non-heads of household. For the subsample of non-heads of household, a positive effect of duplicate coverage on the number of visits to specialists is found. Health related variables, education and income are also important. Results are consistent with the idea that heads of household that buy private insurance are the ones with poor unobservable health conditions. It is argued that this last result is related to the existence of a compulsory public insurance.