title: Redistribution through social health insurance: evidence on citizen preferences.
abstract: The extent of social health insurance (SHI) and supplementary private insurance is frequently analyzed in public choice. Most of these analyses build on the model developed by Gouveia (1997), who defines the extent of SHI as consequence of a choice by self-interested voters. In this model, an indicator reflecting individuals' relative income position and relative risk of falling ill determines the voting decision. Up to now, no empirical evidence for this key assumption has been available. We test the effect of this indicator on individuals' preferences for the extent of SHI in a setting with mandatory SHI that can be supplemented by private insurance. The data is based on a DCE conducted in the field with a representative sample of 1538 German citizens in 2012. Conditional logit and latent class models are used to analyze preference heterogeneity. Our findings strongly support the assumptions of the models. Individuals likely to benefit from public coverage show a positive marginal willingness to pay (MWTP) for both a shift away from other beneficiary groups toward the sick and an expansion of publicly financed resources, and the expected net payers have a negative MWTP and prefer lower levels of public coverage.
authors.affiliation: Department of Law and Economics, Institute of Public Finance, University of Bayreuth, Bayreuth, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Pfarr
authors.affiliation: Department of Law and Economics, Health Management, University of Bayreuth, Bayreuth, Germany. andreas.schmid@uni-bayreuth.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmid
mesh_terms: D000293:Adolescent; D000328:Adult; D003258:Consumer Behavior / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data*; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Discrete choice experiment; Preferences; Social health insurance