Many governments intervene in private health insurance markets to incentivise demand, balance efficiency and equity, and counter adverse selection. In the context of rising health-care costs, this is a complex task, and understanding the relative effectiveness of interventions can help governments design an optimal policy mix. We evaluate the impact of means-testing a premium rebate and increasing an income tax penalty rate on private health insurance hospital coverage in Australia. We employ difference-in-difference (DID) analysis on a Household Income and Labour Dynamics in Australia (HILDA) survey panel of 6,179 individuals. To construct a valid control group, we employ income band restriction and match individuals below the policy income threshold to the treatment group using entropy balancing on pre-treatment covariates and trends. Our analyses suggest that Australia’s Fairer Private Health Insurance Incentives (FPHII) reform in 2012 increased the probability of holding hospital cover by 1.5 percentage points (P < 0.1). The effect was driven by a significant increase in coverage of 2.4 percentage points (P < 0.1) for those in the highest income tier, despite this group experiencing the largest premium increase from the reform. Estimates were relatively robust to sensitivity analyses, including removing those with complicated income streams and removing potential income shifters. Our results suggest that increased tax penalty rates had a stronger impact than means-testing premium rebates, most likely due to the low price elasticity of private health insurance demand in Australia. We discuss these findings in the context of developing an effective policy mix to attract and maintain private health insurance members and promote private health insurance market sustainability.

中文翻译：

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经济状况调查保费回扣和税收处罚对澳大利亚私人医院保险需求的影响*

许多政府干预私人医疗保险市场以刺激需求、平衡效率和公平以及对抗逆向选择。在医疗保健成本上升的背景下，这是一项复杂的任务，了解干预措施的相对有效性可以帮助政府设计最佳政策组合。我们评估了对保费回扣进行经济状况调查和提高所得税罚款率对澳大利亚私人健康保险医院覆盖范围的影响。我们对由 6,179 个人组成的澳大利亚家庭收入和劳动力动态 (HILDA) 调查小组采用差值 (DID) 分析。为了构建一个有效的对照组，我们采用收入带限制，并使用治疗前协变量和趋势的熵平衡将低于政策收入阈值的个人与治疗组匹配。P  < 0.1)。这一影响是由于 最高收入阶层的保险覆盖率显着增加了 2.4 个百分点 ( P < 0.1)，尽管这一群体的保费增长幅度最大。估计对于敏感性分析来说相对稳健，包括去除那些收入流复杂的人和去除潜在的收入转移者。我们的结果表明，提高税收罚款率的影响比通过经济状况调查的保费回扣产生的影响更大，这很可能是由于澳大利亚私人健康保险需求的价格弹性较低。我们在制定有效的政策组合以吸引和维持私人健康保险成员并促进私人健康保险市场可持续性的背景下讨论这些发现。