On the Association between Insurance Deductibles and Prevention Behaviour: Evidence from the Swiss Health System
Abstract
:1. Introduction
2. The Swiss Health System
3. Sample, Variables and Methodology
3.1. Sample
3.2. Variables
3.2.1. Dependent Variables
3.2.2. Independent Variables
3.3. Model and Methodology
4. Results
4.1. Summary Statistics
4.2. Baseline Regression Results
4.3. Further Investigation and Robustness Checks
4.3.1. Alternative Estimation Using Conditional Mixed-Process Modelling
4.3.2. General Prevention Behaviour: Principal Component Analysis
4.3.3. Controlling for Doctor Visits
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
List of Abbreviations
CMP | Conditional mixed-process modelling |
COVID19 | Coronavirus disease 2019 |
FIML | Full information maximum likelihood |
GP | General practitioner |
PCA | Principal component analysis |
SHS | Swiss Health Survey |
SUR | Seemingly unrelated regressions |
VIF | Variance inflation factor |
WHO | World Health Organization |
Appendix A
Variable | Description | Details |
---|---|---|
Physical_activity | Physical activity | 1 for none, 2 for 1–2 days per week and 3 for more than 3 days per week |
diet | Diet based on the number of fruits/vegetables intake per day | 1 for less than 5 portions per week, 2 for 0–2 portions per day, 3 for 3–4 portions per day and 4 for 5 or more portions per day |
tobacco | Tobacco consumption | 1 for a daily smoker, 2 for an occasional smoker and 3 for a nonsmoker |
alcohol | Categorical daily alcohol consumption in grams, which was calculated on a whole-sample percentile basis | 1 for more than 14.5 g 2 for 7 g < consumption < 14.5 g 3 for 3.66 g < consumption < 7 g 4 for less than 3.66 g |
deductible | Answer to the following question: What is your personal annual deductible? | 1 for CHF 300 to <500 2 for CHF 500 to <1000 3 for CHF 1000 to <1500 4 for CHF 1500 to <2000 5 for CHF 2000 to <2500 6 for CHF 2500 or more |
age | Age in number of years | 18–99 |
education | Education level | 1 for have not finished obligatory school to 20 for having a Doctorate degree or equivalent |
single_household | Dummy for a single household | 1 if the household is composed of a single individual and 0 otherwise |
gender | Male or female | 1 for male, 0 for female |
nationality | Nationality | 1 for born Swiss, 2 for Swiss by naturalisation and 3 for another nationality |
employed | Employment dummy | 1 if employed, 0 otherwise |
German | Dummy for German-speaking | 1 if German speaking, 0 otherwise |
French | Dummy for French-speaking | 1 if French speaking, 0 otherwise |
Italian | Dummy for Italian-speaking | 1 if Italian speaking, 0 otherwise |
doctor_visit | Dummy for visiting a doctor | 1 for having visited a doctor within the last 12 months, 0 otherwise |
lottery | Answer to the following question: Have you ever played the lottery? | 1 for answering yes, 0 otherwise |
pessimism | Answer to the following question: To what extent you consider yourself pessimistic? | 1 for never 2 for somedays 3 for more than 50% of the time 4 for almost every day |
altruism | Answer to the following question: Do you consider yourself altruistic? | 1 for answering yes, 0 otherwise |
References
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Variable | N | Mean | Std. Dev. | Min | Max |
---|---|---|---|---|---|
physical_activity | 21,158 | 1.976 | 0.788 | 1 | 3 |
diet | 21,108 | 2.68 | 0.92 | 1 | 4 |
tobacoo | 22,132 | 2.561 | 0.782 | 1 | 3 |
alcohol | 15,730 | 2.495 | 1.114 | 1 | 4 |
deductible | 16,381 | 3.014 | 2.069 | 1 | 6 |
age | 18,832 | 49.36 | 18.667 | 15 | 98 |
education | 19,412 | 9.996 | 5.369 | 1 | 20 |
single_household | 22,134 | 0.156 | 0.363 | 0 | 1 |
gender | 18,832 | 0.469 | 0.499 | 0 | 1 |
nationality | 22,097 | 1.566 | 0.828 | 1 | 3 |
employed | 22,134 | 0.652 | 0.476 | 0 | 1 |
German | 22,134 | 0.663 | 0.473 | 0 | 1 |
French | 22,134 | 0.264 | 0.441 | 0 | 1 |
Italian | 22,134 | 0.072 | 0.259 | 0 | 1 |
doctor_visit | 19,479 | 0.823 | 0.382 | 0 | 1 |
lottery | 18,435 | 0.281 | 0.45 | 0 | 1 |
pessimism | 18,507 | 1.468 | 0.709 | 1 | 4 |
altruism | 19,483 | 0.348 | 0.476 | 0 | 1 |
Deductible Level in CHF | |||||
---|---|---|---|---|---|
Entire Sample | |||||
Prevention Variables | N | Mean | Std. Dev. | Min | Max |
physical_activity | 4834 | 2.047 | 0.802 | 1 | 3 |
diet | 4801 | 2.59 | 0.946 | 1 | 4 |
tobacoo | 5752 | 2.515 | 0.809 | 1 | 3 |
alcohol | 3149 | 2.5 | 1.129 | 1 | 4 |
300 | |||||
physical_activity | 6501 | 1.829 | 0.8 | 1 | 3 |
diet | 6492 | 2.702 | 0.909 | 1 | 4 |
tobacoo | 6527 | 2.578 | 0.781 | 1 | 3 |
alcohol | 4649 | 2.514 | 1.134 | 1 | 4 |
500 | |||||
physical_activity | 2294 | 1.874 | 0.786 | 1 | 3 |
diet | 2290 | 2.717 | 0.903 | 1 | 4 |
tobacoo | 2307 | 2.534 | 0.81 | 1 | 3 |
alcohol | 1674 | 2.502 | 1.145 | 1 | 4 |
1000 | |||||
physical_activity | 897 | 1.965 | 0.768 | 1 | 3 |
diet | 893 | 2.704 | 0.912 | 1 | 4 |
tobacco | 899 | 2.519 | 0.808 | 1 | 3 |
alcohol | 723 | 2.549 | 1.091 | 1 | 4 |
1500 | |||||
physical_activity | 1808 | 2.046 | 0.762 | 1 | 3 |
diet | 1808 | 2.663 | 0.912 | 1 | 4 |
tobacco | 1812 | 2.591 | 0.76 | 1 | 3 |
alcohol | 1448 | 2.539 | 1.086 | 1 | 4 |
2000 | |||||
physical_activity | 727 | 2.089 | 0.734 | 1 | 3 |
diet | 728 | 2.663 | 0.886 | 1 | 4 |
tobacco | 728 | 2.511 | 0.804 | 1 | 3 |
alcohol | 619 | 2.381 | 1.102 | 1 | 4 |
2500 | |||||
physical_activity | 4097 | 2.135 | 0.727 | 1 | 3 |
diet | 4096 | 2.732 | 0.919 | 1 | 4 |
tobacco | 4107 | 2.618 | 0.72 | 1 | 3 |
alcohol | 3468 | 2.454 | 1.073 | 1 | 4 |
Variables | Deductible | Age | Education | Single_Household | Gender | Nationality | Employed | German | French | Italian | Altruism | Doctor_Visit | Lottery | Pessimism | Physical_Activity | Diet | Tobacco | Alcohol |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
deductible | 1.000 | |||||||||||||||||
age | −0.339 | 1.000 | ||||||||||||||||
education | 0.292 | −0.190 | 1.000 | |||||||||||||||
single_household | −0.027 | 0.032 | −0.045 | 1.000 | ||||||||||||||
gender | 0.071 | −0.069 | 0.143 | −0.067 | 1.000 | |||||||||||||
nationality | 0.074 | −0.126 | 0.097 | 0.027 | 0.058 | 1.000 | ||||||||||||
employed | 0.246 | −0.559 | 0.242 | −0.020 | 0.142 | 0.073 | 1.000 | |||||||||||
German | 0.007 | 0.017 | 0.006 | −0.072 | −0.036 | −0.174 | 0.089 | 1.000 | ||||||||||
French | −0.020 | −0.020 | −0.017 | 0.083 | 0.024 | 0.130 | −0.080 | −0.864 | 1.000 | |||||||||
Italian | 0.023 | 0.005 | 0.019 | −0.014 | 0.027 | 0.100 | −0.026 | −0.353 | −0.165 | 1.000 | ||||||||
altruism | −0.065 | 0.024 | 0.085 | 0.018 | −0.195 | −0.037 | 0.032 | 0.064 | −0.043 | −0.046 | 1.000 | |||||||
doctor_visit | −0.200 | 0.198 | −0.103 | 0.036 | −0.105 | −0.027 | −0.201 | −0.021 | 0.067 | −0.084 | 0.031 | 1.000 | ||||||
lottery | 0.065 | −0.167 | 0.001 | −0.008 | −0.002 | −0.235 | 0.149 | 0.067 | −0.036 | −0.064 | 0.006 | −0.003 | 1.000 | |||||
pessimism | −0.080 | −0.046 | −0.003 | 0.136 | 0.011 | 0.014 | 0.074 | −0.110 | 0.049 | 0.124 | 0.001 | 0.052 | 0.021 | 1.000 | ||||
physical_activity | 0.076 | −0.034 | 0.115 | −0.027 | −0.008 | −0.026 | −0.001 | 0.154 | −0.132 | −0.057 | 0.015 | 0.042 | 0.013 | −0.161 | 1.000 | |||
diet | 0.030 | −0.009 | 0.102 | −0.014 | −0.272 | −0.024 | −0.011 | −0.036 | 0.047 | −0.016 | 0.101 | 0.044 | −0.013 | −0.021 | 0.198 | 1.000 | ||
tobacco | −0.062 | −0.090 | −0.131 | 0.178 | 0.018 | 0.055 | −0.029 | −0.043 | −0.014 | 0.110 | −0.046 | −0.045 | −0.149 | 0.097 | −0.072 | −0.135 | 1.000 | |
alcohol | −0.076 | 0.085 | −0.042 | 0.021 | 0.275 | −0.072 | −0.076 | −0.115 | 0.094 | 0.052 | −0.066 | −0.036 | 0.057 | 0.064 | −0.028 | −0.170 | 0.103 | 1.000 |
(1) | (2) | (3) | (4) | |
---|---|---|---|---|
Prevention Behaviour | Physical_Activity | Diet | Tobacco | Alcohol |
deductible | 0.0400 *** | 0.0154 *** | 0.0400 *** | −0.00260 |
(7.79) | (3.10) | (6.39) | (−0.46) | |
age | −0.0120 *** | 0.00349 *** | 0.0142 *** | −0.00192 ** |
(−16.18) | (4.94) | (16.11) | (−2.33) | |
education | 0.0175 *** | 0.0278 *** | 0.0294 *** | −0.00581 *** |
(9.00) | (14.85) | (12.33) | (−2.71) | |
single_household | −0.0512 ** | −0.125 *** | −0.249 *** | 0.0255 |
(−2.03) | (−5.24) | (−8.39) | (0.92) | |
gender | 0.131 *** | −0.619 *** | −0.237 *** | −0.806 *** |
(6.57) | (−32.02) | (−9.85) | (−36.53) | |
nationality | −0.0711 *** | −0.0126 | −0.0375 ** | 0.0487 *** |
(−5.43) | (−1.01) | (−2.44) | (3.32) | |
employed | 0.00620 | −0.0899 *** | −0.123 *** | 0.127 *** |
(0.25) | (−3.75) | (−4.05) | (4.54) | |
German | 0.228 *** | 0.0873 ** | 0.150 *** | 0.237 *** |
(6.07) | (2.47) | (3.46) | (5.72) | |
French | 0.00632 | 0.271 *** | 0.120 *** | 0.0923 ** |
(0.16) | (7.16) | (2.59) | (2.09) | |
Italian | 0 | 0 | 0 | 0 |
(.) | (.) | (.) | (.) | |
doctor_visit | 0.0408 | −0.00843 | 0.0854 *** | −0.0290 |
(1.55) | (−0.33) | (2.74) | (−1.02) | |
lottery | −0.00792 | −0.00530 | 0.0910 *** | −0.0801 *** |
(−0.36) | (−0.25) | (3.37) | (−3.37) | |
pessimism | −0.149 *** | −0.0838 *** | −0.119 *** | −0.0453 *** |
(−10.23) | (−6.09) | (−7.07) | (−2.75) | |
altruism | 0.123 *** | 0.119 *** | −0.0167 | 0.0269 |
(6.17) | (6.21) | (−0.69) | (1.23) | |
cut1 | ||||
_cons | −0.826 *** | −1.269 *** | −0.0585 | −1.078 *** |
(−10.09) | (−16.16) | (−0.61) | (−11.74) | |
cut2 | ||||
_cons | 0.247 *** | −0.0251 | 0.208 ** | −0.331 *** |
(3.02) | (−0.32) | (2.17) | (−3.61) | |
cut3 | ||||
_cons | 0.982 *** | 0.415 *** | ||
(12.57) | (4.54) | |||
N | 13,988 | 13,979 | 14,032 | 10,828 |
(1) | (2) | (3) | (4) | |
---|---|---|---|---|
Prevention Behaviour | Physical_Activity | Diet | Tobacco | Alcohol |
deductible | 0.383 *** | 0.366 *** | 0.385 *** | −0.356 *** |
(96.45) | (97.45) | (80.34) | (−85.99) | |
age | −0.0000539 | 0.0133 *** | 0.0207 *** | −0.0137 *** |
(−0.07) | (19.16) | (25.63) | (−17.14) | |
education | −0.00915 *** | 0.000109 | −0.00422 * | 0.0186 *** |
(−4.84) | (0.06) | (−1.95) | (8.94) | |
single_household | −0.0597 ** | −0.130 *** | −0.222 *** | 0.0307 |
(−2.44) | (−5.51) | (−8.09) | (1.13) | |
gender | 0.0155 | −0.650 *** | −0.297 *** | −0.638 *** |
(0.80) | (−34.06) | (−13.52) | (−29.46) | |
nationality | −0.0271 ** | 0.0205 * | 0.00691 | 0.0190 |
(−2.12) | (1.66) | (0.48) | (1.33) | |
employed | −0.157 *** | −0.249 *** | −0.360 *** | 0.256 *** |
(−6.37) | (−10.49) | (−12.73) | (9.33) | |
German | 0.230 *** | 0.120 *** | 0.155 *** | 0.161 *** |
(6.33) | (3.42) | (3.84) | (3.97) | |
French | 0.0528 | 0.291 *** | 0.128 *** | 0.0236 |
(1.36) | (7.77) | (2.96) | (0.55) | |
doctor_visit | 0.331 *** | 0.291 *** | 0.369 *** | −0.326 *** |
(12.93) | (11.75) | (13.00) | (−11.82) | |
lottery | −0.0809 *** | −0.0811 *** | −0.0159 | −0.00244 |
(−3.73) | (−3.85) | (−0.65) | (−0.10) | |
pessimism | −0.0365 ** | 0.0173 | 0.0114 | −0.126 *** |
(−2.57) | (1.27) | (0.73) | (−7.86) | |
altruism | 0.148 *** | 0.145 *** | 0.0275 | −0.0259 |
(7.56) | (7.65) | (1.24) | (−1.21) | |
N | 13,988 | 13,979 | 14,032 | 10,828 |
PREVENT | |
---|---|
deductible | 0.0323 *** |
(6.23) | |
age | 0.00120 |
(1.58) | |
education | 0.0264 *** |
(13.27) | |
single_household | −0.153 *** |
(−5.95) | |
gender | −0.682 *** |
(−33.15) | |
nationality | −0.0125 |
(−0.93) | |
employed | −0.0512 ** |
(−1.99) | |
German | 0.262 *** |
(6.88) | |
French | 0.211 *** |
(5.21) | |
doctor_visit | 0.0356 |
(1.36) | |
lottery | −0.00424 |
(−0.19) | |
pessimism | −0.138 *** |
(−9.05) | |
altruism | 0.0893 *** |
(4.42) | |
N | 10,763 |
(1) | (2) | (3) | (4) | |
---|---|---|---|---|
Prevention Behaviour | Physical_Activity | Diet | Tobacco | Alcohol |
deductible | 0.379 *** | 0.363 *** | 0.381 *** | −0.352 *** |
(95.97) | (97.02) | (79.89) | (−85.57) | |
age | 0.000568 | 0.0138 *** | 0.0213 *** | −0.0143 *** |
(0.79) | (19.99) | (26.46) | (−17.92) | |
education | −0.00846 *** | 0.000781 | −0.00352 | 0.0179 *** |
(−4.48) | (0.43) | (−1.63) | (8.58) | |
single_household | −0.0669 *** | −0.137 *** | −0.230 *** | 0.0416 |
(−2.73) | (−5.80) | (−8.38) | (1.53) | |
gender | −0.0187 | −0.681 *** | −0.335 *** | −0.601 *** |
(−0.97) | (−35.87) | (−15.35) | (−27.96) | |
nationality | −0.0269 ** | 0.0202 | 0.00685 | 0.0200 |
(−2.11) | (1.63) | (0.48) | (1.40) | |
employed | −0.173 *** | −0.263 *** | −0.377 *** | 0.274 *** |
(−7.03) | (−11.12) | (−13.35) | (10.00) | |
German | 0.234 *** | 0.122 *** | 0.158 *** | 0.159 *** |
(6.42) | (3.50) | (3.93) | (3.93) | |
French | 0.0632 | 0.300 *** | 0.138 *** | 0.0160 |
(1.63) | (8.01) | (3.21) | (0.37) | |
lottery | −0.0796 *** | −0.0808 *** | −0.0152 | −0.00346 |
(−3.68) | (−3.84) | (−0.62) | (−0.15) | |
pessimism | −0.0224 | 0.0304 ** | 0.0269 * | −0.140 *** |
(−1.59) | (2.24) | (1.72) | (−8.74) | |
altruism | 0.145 *** | 0.141 *** | 0.0230 | −0.0209 |
(7.39) | (7.45) | (1.04) | (−0.98) | |
N | 13,991 | 13,982 | 14,035 | 10,831 |
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Courbage, C.; Nicolas, C. On the Association between Insurance Deductibles and Prevention Behaviour: Evidence from the Swiss Health System. J. Risk Financial Manag. 2021, 14, 150. https://doi.org/10.3390/jrfm14040150
Courbage C, Nicolas C. On the Association between Insurance Deductibles and Prevention Behaviour: Evidence from the Swiss Health System. Journal of Risk and Financial Management. 2021; 14(4):150. https://doi.org/10.3390/jrfm14040150
Chicago/Turabian StyleCourbage, Christophe, and Christina Nicolas. 2021. "On the Association between Insurance Deductibles and Prevention Behaviour: Evidence from the Swiss Health System" Journal of Risk and Financial Management 14, no. 4: 150. https://doi.org/10.3390/jrfm14040150