Preference for National Health Service use and the demand for private health insurance in Spain

In National Health Systems (“NHS”) the funding and provision of health care co-exists with a developing market for private (supplementary) health insurance. In this setting, interactions between the public and private sector are important and likely to influence the demand for private health insurance (“PHI”). This paper empirically examines the interactions between PHI and NHS use using a representative survey for Catalonia (Spain). Our findings show that PHI stands as a financial tool for accessing private health care in Spain. Use of NHS care and the demand for private health insurance are simultaneously determined. The individual take-up of PHI results from a lower use of primary and specialized NHS care. Furthermore, preferences for the NHS care are influenced by captivity towards the NHS care.