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The European Journal of Health Economics
Published in: The European Journal of Health Economics 2/2021

Open Access 01-03-2021 | Original Paper

Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia

Authors: Andrey Aistov, Ekaterina Aleksandrova, Christopher J. Gerry

Published in: The European Journal of Health Economics | Issue 2/2021

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Abstract

This paper contributes to the discussion around ex-post (increased utilisation of health care) and ex-ante (changes in health behaviours) moral hazard in supplemental private health insurance. Applying a range of methodologies to data from the Russian Longitudinal Monitoring Survey—Higher School of Economics we exploit a selection mechanism in the data to compare the impact of workplace provided and individually purchased supplemental health insurance on the utilisation of health care, on a range of health behaviours and on self-assessed health. We find compelling policy-relevant evidence of ex-post moral hazard that confirms a theoretical prediction and empirical regularity found in other settings. In contrast to other empirical findings though, our data reveals evidence of ex-ante moral hazard demonstrated by clear behavioural differences between those with self-funded supplemental health insurance and those for whom the workplace finances the additional insurance. We find no evidence that either form of insurance is related to improved self-assessed health.
Appendix
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Footnotes
1
In fact, there is technically a fourth option as, particularly in the regions, enterprises who cannot enter the corporate VHI sector choose to finance their own medical facilities or send their employees to enterprise owned health resorts or to commission generalised preventative treatment for staff.
 
2
The RLMS-HSE is a survey conducted by Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology RAS (details at http://​www.​cpc.​unc.​edu/​projects/​rlms(English) and http://​www.​hse.​ru/​org/​hse/​rlms (Russian).
 
3
Although the official retirement age in Russia remains 55 for women and 60 for men, in the period covered by our data, many Russians continue to work in one or more jobs beyond this official retirement age. We therefore follow the Russian Statistical Agency (ROSSTAT) in identifying 72 as the cut off age for the economically active population.
 
4
We exclude from our analysis the small number of respondents who report ‘other’ as the source of finance for their VHI and concentrate on the distinction between enterprise funded, self-funded and no VHI.
 
6
Taking into account multiple comparisons and the large sample size, there are just two statistically significant results with reliable p values: working males who have not been hospitalised in the last year are more likely to have moved into VHI employment, and working females increase their income by moving into VHI employment. This is consistent with no adverse selection.
 
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Metadata
Title
Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia
Authors
Andrey Aistov
Ekaterina Aleksandrova
Christopher J. Gerry
Publication date
01-03-2021
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 2/2021
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-020-01252-2

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