Do people with private health insurance attach a higher value to health and healthcare than those without?

A recent study undertaken by Dr Anna Hobbins, Postdoctoral researcher at CÚRAM, the SFI Research Centre for Medical Devices, led by Professor Ciaran O’Neill from the Center for Public Health at Queens University Belfast, together with colleagues from NUI Galway, the Office of Health Economics in London and Axentiva Solutions in Spain, suggests that there is no meaningful difference in how people value health, whether they have private health insurance or not while other studies have shown it to significantly impact on whether and how people use the healthcare system in Ireland.

“Differences in health service use between people with and without health insurance have been observed in Ireland with respect to preventive, primary and tertiary healthcare services and this is a major source of concern for policy-makers” explains Dr Hobbins. “We wanted to find out whether the differences in how people with and without health insurance use the healthcare system relates to a difference in the value they assign to their health.”

Almost half of the population in Ireland hold private health insurance. Studies examining the factors that explain insurance uptake suggest this is because it is perceived as affording faster access to public services and may actually afford faster access to services. Approximately 37% of the population have a medical card, just under half have private health insurance and approximately 6% have both private and public insurance.

To conduct this research, Dr Hobbins and the team used specific valuation tasks with a sample of 1160 residents of Ireland during 2015/16. The study provided no compelling evidence that any meaningful differences exists in the values accorded to health between those with and without health insurance.

Professor Abhay Pandit, Scientific Director at CÚRAM commented: “This study provides an important perspective for making healthcare and access decisions at policy level in Ireland. I’m delighted to see our researchers work contributing to these important conversations, supporting CÚRAM’s mission of improving quality of life for people, in particular those with long term chronic healthcare needs.”

Earlier studies have drawn attention to the greater likelihood of healthcare needs having gone unmet among those without insurance relative to those with. In Ireland, equity has been highlighted not just as an important policy goal, but as one of the guiding principles in the national health strategy.

Significant research has been carried out before now on differences within the population with respect to how they use the healthcare system. Whether the differences in how we use the system relate to our ethnicity, socio-economic status, gender, age or body shape, these studies are useful in identifying any disparities or inequalities and what impact health policies have had in addressing them.

This study suggests that differential use of the healthcare system in Ireland is grounded in the differential access afforded by insurance not preferences for health. The findings suggest that the current position in Ireland, where the state subsidizes the acquisition of insurance through the provision of tax relief and charges less than the full economic cost of publicly provided services, runs counter to the pursuit of equity and may accentuate unwarranted disparities in service use.

Dr Hobbins continued: “Our analysis provides no compelling evidence that there exist differences in the preferences for health among those with and without private health insurance in Ireland. It follows that observed differences in use between those with and without insurance more likely relate to the differential access private health insurance affords than to differences in preferences.”

Dr Anna Hobbins is a postdoctoral researcher working on economic evaluation of medical devices at CÚRAM and Health Economics and Policy Analysis Centre NUI Galway. She completed her PhD in Queen’s University Belfast which involved producing the Irish “value set”, “population norms” using the EQ-5D-5L system. The output from her work, which has involved collaboration with colleagues across multiple disciplines, has been published in a range of leading national and international peer-reviewed journals. To access the full paper please visit

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