Observational studyPloS one2018
Associations of lack of voluntary private insurance and out-of-pocket expenditures with health inequalities. Evidence from an international longitudinal survey in countries with universal health coverage.
Observational study in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed.
- The role of voluntary health insurance in frailty onset and progression among older and aging European adults: a survival analysis, 2013-2022.Frontiers in public health · 2026Article
- Integrating social determinants of health into global approaches to early-onset type 2 diabetes.Journal of diabetes and its complications · 2025Article
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- The Role of Supplementary Insurance in Achieving Universal Health Coverage: A Comprehensive Review.Medical journal of the Islamic Republic of Iran · 2024Review
- Socioeconomic inequalities in health outcomes among Thai older population in the era of Universal Health Coverage: trends and decomposition analysis.International journal for equity in health · 2023Article
- Vulnerable patients forgo health care during the first wave of the Covid-19 pandemic.Preventive medicine · 2021Article
- The Effect of Additional Private Health Insurance on Mortality in the Context of Universal Public Health Insurance.International journal of environmental research and public health · 2021Article
- The impacts of health insurance on financial strain for people with chronic diseases.BMC public health · 2021Article
- Access to an Electronic Health Record: A Polish National Survey.International journal of environmental research and public health · 2020Article
- What Are the Determinants of the Decision to Purchase Private Health Insurance in China?International journal of environmental research and public health · 2020Article
- Self-Rated Health Status Based on the Type of Health Insurance: A Socioeconomic Perspective.Inquiry : a journal of medical care organization, provision and financingArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
objectivesIn countries with universal health coverage (UHC), national public health insurances cover 70% of health expenditures on average, but health care user fees and out-of-pocket expenditures have been neglected in empirical patient-centered health inequality research. This study is the first to investigate how health care-related factors are associated with health status among middle-aged and elderly people-vulnerable groups for the burden of illness-in countries with UHC.
designLongitudinal observational cohort study.
settingPopulation-based cohort Survey of Health, Ageing and Retirement in Europe (SHARE) in twelve countries with UHC.
participantsNon-institutionalized people aged 50 and older (n = 29,260). Two subsamples were also used: participants without global activity limitation at baseline (n = 16,879) and participants without depression at baseline (n = 21,178).
main outcome measuresRisk of death, risk of global activity limitations, and risk of depression. We used mixed-effects Cox proportional hazards regressions to estimate hazard ratios (HR) for all-cause mortality, physical limitations, and depression.
resultsHaving a voluntary private insurance to cover health expenses not included in the public health care system (44.1% of the total sample) was a protective factor for all outcomes (HR≤0.91), controlling for a large range of socio-economic variables. On the contrary, having out-of-pocket expenditures (62.4%) was a risk factor (HR≥1.12).
conclusionsUHC systems are not free from health inequalities: there is a potential effect of lack of voluntary private insurance and out-of-pocket expenditures on mortality and health. Health care-related factors should be at focus in future researches designed to understand and address health inequalities. Reducing out-of-pocket expenditures and developing voluntary private insurance may protect against premature illness and death.
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