Financial Knowledge and Private Health Insurance: Does Age Matter?

(1) Background: The paper focuses on the relationship between financial knowledge (FK) and holding private health insurance (PHI), and also focuses on the effect of age on the aforementioned relationship. (2) Method: The study was carried out on a sample of 8055 individuals taken from the 2016 Financial Competences Survey (the only one available), prepared by the Bank of Spain. Unlike previous studies that limited themselves to considering numeracy as a proxy for FK, in this study, two levels of FK-basic and advanced-are considered. (3) Results: The results indicate that a higher level of FK, specifically advanced FK, increases the probability of an individual holding PHI. Regarding age, it has been observed that the relationship between FK and PHI is only relevant in middle and older age, but not in younger and adults. Therefore, it is appropriate to differentiate between basic and advanced FK, and we confirm that age exerts a moderating effect on the influence of FK on PHI. (4) Conclusion: We conclude that FK-specifically, advanced FK for middle-aged and older people-is relevant to the likelihood of an individual holding PHI, which can improve health and financial wellbeing.

Private Health Insurance and Financial Risk Taking in Spain-The Moderating Effect of Subjective Risk Tolerance.

This study focuses on the effect of private health insurance on financial risk taking in Spanish households. According to the arguments related to the background risk, we propose two hypotheses: the first predicts a positive relationship between health insurance and risk taking and the second asserts that attitude to risk moderates this relationship. Spain is a good laboratory because it has a National Health System (NHS) that offers healthcare coverage to the entire population, which could eliminate the effect of health insurance on risk taking. Based on a sample of 6110 households obtained from the Household Finance Survey (EFF), our results confirm both hypotheses. Specifically, we show that private health insurance significantly increases a household's portfolio risk, especially in households with greater risk aversion. The results are concordant with the scarce amount of previous empirical evidence obtained in other contexts and are robust for different subsamples and estimation methods.

Nursing Homes: Affiliation to Large Chains, Quality and Public-Private Collaboration.

The objective of this paper was to estimate the influence of being affiliated with an NH chain on perceived consumer quality, and whether this relationship is affected by maintaining a collaboration agreement with public administrations. We used a combination of theoretical foundations: (1) From the consumer perspective, we focussed on online reviews of the quality of nursing homes (NHs); (2) from the industrial organisation literature, we proposed arguments regarding the advantages and disadvantages of belonging to a chain; (3) the theory of transaction costs was used to explain public-private collaboration. The study was carried out on a sample of 642 chain-affiliated Spanish NHs, with data from quality scores downloaded from the website topMayores.es. We distinguished between the six largest chains and the rest. We applied linear regression models. The results show that NHs affiliated with one of the largest NH chains obtained worse quality scores in the assessment made by users, although quality scores improved for the largest chains of NHs involved in an agreement with the public administration.

Arrangements with the NHS for providing healthcare services: do they improve financial performance of private for-profit hospitals in Spain?

BACKGROUND: In developed countries around the world there is a trend to enhance the public-private collaboration in healthcare. In Spain, a decentralized country with a NHS funded with taxes and universal coverage, commissioning to for-profit private hospitals the production of healthcare services to specific patients that are publicly insured is a traditional practice. Around 43% of the for-profit private hospitals in Spain have a commissioning agreement with the NHS to diagnose or treat patients on public tariffs. These revenues represent 26% of the total revenues of private for-profit hospitals. The research question of this study is if commissioning with the NHS improves the financial performance of private-for-profit hospitals in Spain. METHODS: With a long panel (2000-2017) of for-profit hospitals we estimate a model for the financial performance (return on assets) using commissioning as main explanatory variable and other variables as control (variables financial indicators and structural information). Specific models are estimated for subgroups of hospitals according to size and specialization. The models are estimated by panel regression with fixed effects and GMM as robustness. RESULTS: Private for-profit hospitals that have commissioning with NHS obtain higher financial performance than no-commissioning hospitals. This effect varies depending on hospital size and type (hospital specialization), the advantage being more relevant for general hospitals and particularly for hospital with at least 50 beds. CONCLUSIONS: Commissioning with the NHS is a promising source of financial profitability for general acute private for-profit hospitals. The evidence provided by this study may orientate the NHS in the regulation and negotiation of commissioning contracts in healthcare.