Universal health insurance under a dual system, evidence of adverse selection against the public sector: the case of Chile

This paper examines health insurance choice and its dynamics using panel data from Chile’s National Socio Economic Characterization Survey 1996-2001-2006. Evidence indicates that private insurance is losing customers to the public sector. Two different logistic models are used to explain the determinants of insurance choice as well as what drives the decision to move from the private to the public sector and vice versa. Income is a highly important determinant of choice, as well as age, education, geographical location and health status. Evidence of adverse selection against the public sector was found in both decision models. The results of this paper are in line with most of the previous investigations done on Chile’s health insurance system but it advance previous knowledge on the topic by including the dynamism and power for causal inference that panel data permits.