If public resources were unlimited, there would be no gaps in health
coverage and no real need for VHI. However, most health systems face
fiscal constraints and VHI is often seen as a way to address these
pressures. This study draws from the experiences of 34 countries to
assess VHI's contribution to health spending and to understand its role
in Europe and in relation to publicly financed coverage. It looks at who
sells VHI, who purchases it and why. It also reviews public policy
towards VHI at national and EU levels and the related national policy
debates.
The analysis shows that while the different markets for VHI vary
considerably in size, operation and regulation the vast majority are
small. Where there are substantial markets these tend to be the oldest
ones, having a tradition of non-profit insurers, and to be the most
heavily regulated to ensure VHI policies are accessible and affordable.
The study also suggests that VHI is normally a better way of meeting
population health needs than out-of-pocket payments, although there are
notable exceptions. VHI can contribute to financial protection,
especially where it plays a substitutive and complementary role covering
co-payments. However, it is a complex, challenging and highly
context-specific policy instrument that may undermine other health
system goals, including equitable access, efficiency, transparency and
accountability, even where markets are well regulated. Policy-makers
should therefore exercise real caution before expanding VHI to fill
coverage gaps..
This volume and its companion set of country profiles were developed
jointly by the Observatory's LSE hub and the WHO Regional Office for
Europe. The study draws on contributions from national experts from the
EU, EFTA and other countries in Europe.
