Assessment of Trends in Voluntary Health Insurance Expenditure Across Europe and possible impact of COVID-19 pandemic: an interrupted time series analysis, 2015-24
1
Department of Public Health, University "Federico II " of Naples, Naples, Italy
Popul. Med. 2026;8(Supplement Supplement 1):A3764
ABSTRACT
BACKGROUND:
Voluntary Health Insurance (VHI) plays an increasingly important role within European health financing systems alongside publicly financed coverage1. However, evidence on long-term trends in VHI expenditure across Europe remains limited2. Therefore, this study examined trends in VHI expenditure in 24 European countries over the period 2015- 2024 and assessed the impact of the COVID-19 pandemic.
METHODS:
Data on VHI expenditure (Euros per capita) were obtained from the OECD Data Explorer, while macroeconomic indicators were sourced from the World Bank. Mixed-effects linear regression models were used to assess overall and stratified trends, adjusting for current health expenditure as a percentage of GDP. Analyses were stratified by European macro-regions (Southern, Eastern, Western, and Northern Europe) and by prevailing health system models (Beveridge, Bismarck, and mixed systems). Interrupted time series analysis was applied to assess pandemic-related changes, with 2020 specified as the intervention point.
RESULTS:
VHI expenditure increases were observed in specific regional and institutional contexts, particularly in Southern Europe (Coeff = 5.03; 95% CI: 3.89-6.17; p < 0.001) and Northern Europe (Coeff = 2.72; 95% CI: 1.39-4.05; p < 0.001), as well as in countries with Beveridge health systems (Coeff = 3.26; 95% CI: 2.02-4.49; p < 0.001) and mixed systems (Coeff = 1.41; 95% CI: 0.06-2.75; p = 0.041). Interrupted time series analyses showed no sustained change in VHI expenditure trends associated with the COVID-19 pandemic at the European level, despite short-term disruptions in some countries, including Belgium, Denmark, Spain, Italy, the Netherlands, and Poland.
CONCLUSIONS:
VHI expenditure trends across Europe primarily reflect longer-term structural dynamics within national health systems rather than short-term pandemic effects. The marked heterogeneity across regions highlights the importance of contextualized analyses when assessing the role of VHI and its implications for equity, access to care, and financial protection under Universal Health Coverage3.
Voluntary Health Insurance (VHI) plays an increasingly important role within European health financing systems alongside publicly financed coverage1. However, evidence on long-term trends in VHI expenditure across Europe remains limited2. Therefore, this study examined trends in VHI expenditure in 24 European countries over the period 2015- 2024 and assessed the impact of the COVID-19 pandemic.
METHODS:
Data on VHI expenditure (Euros per capita) were obtained from the OECD Data Explorer, while macroeconomic indicators were sourced from the World Bank. Mixed-effects linear regression models were used to assess overall and stratified trends, adjusting for current health expenditure as a percentage of GDP. Analyses were stratified by European macro-regions (Southern, Eastern, Western, and Northern Europe) and by prevailing health system models (Beveridge, Bismarck, and mixed systems). Interrupted time series analysis was applied to assess pandemic-related changes, with 2020 specified as the intervention point.
RESULTS:
VHI expenditure increases were observed in specific regional and institutional contexts, particularly in Southern Europe (Coeff = 5.03; 95% CI: 3.89-6.17; p < 0.001) and Northern Europe (Coeff = 2.72; 95% CI: 1.39-4.05; p < 0.001), as well as in countries with Beveridge health systems (Coeff = 3.26; 95% CI: 2.02-4.49; p < 0.001) and mixed systems (Coeff = 1.41; 95% CI: 0.06-2.75; p = 0.041). Interrupted time series analyses showed no sustained change in VHI expenditure trends associated with the COVID-19 pandemic at the European level, despite short-term disruptions in some countries, including Belgium, Denmark, Spain, Italy, the Netherlands, and Poland.
CONCLUSIONS:
VHI expenditure trends across Europe primarily reflect longer-term structural dynamics within national health systems rather than short-term pandemic effects. The marked heterogeneity across regions highlights the importance of contextualized analyses when assessing the role of VHI and its implications for equity, access to care, and financial protection under Universal Health Coverage3.
| eISSN: | 2654-1459 |
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