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Health systems in transition
Portugal
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3.5 Voluntary health insurance
3.5.1 Market role and size
The private insurance market, given by the number of individuals covered
by individual or group private health insurance, has grown, reaching almost
2.6 million people covered in 2015 (around 25.8% of the population), which
represents a 3.5% growth compared with 2012 (ASF, 2016; ERS, 2015c). The
main role of private VHI is supplementary, speeding access to elective hospital
treatment and ambulatory consultations and choice of provider) and, only rarely,
complementary, covering services excluded from the NHS.
3.5.2 Market structure
Similarly to the number of people covered by VHI, the number of insurance
policies has also increased, having VHI reached a market share of 25.8% in
2015 (ASF, 2016). Notwithstanding, due to the existence of a universal NHS,
the private insurance market in Portugal is small. In the European context,
countries such as Germany or the Netherlands have private insurance markets
with a bigger dimension, given the nature of their health systems. Even so,
Portugal is the country with the highest ratio of premium per GDP (0.33%) and
the second highest ratio of gross premium per 100 000 population (€5.2 million),
compared with countries such as the United Kingdom, Denmark, Italy,
Finland and Greece, which shows the growing importance of VHI in Portugal
(ERS, 2015c).
In 2013, there were 26 insurers selling VHI in Portugal, with
Fidelidade
and
Ocidental Seguros
having together more than 50% of market share, as
defined by the proportion of total premium income (ERS, 2015c). Over time,
the VHI market has become more concentrated, ref lecting an increased
concentration in the banking and insurance sectors more broadly. Based on all
26 insurers’ market shares, it is possible to describe the Portuguese VHI market
as moderately concentrated (ERS, 2015c).
3.5.3 Market conduct
Insurers have established measures to prevent moral hazard (the assumption
that insured people overuse health care services because they have insurance)
to avoid paying excessive amounts for claims. Some examples include: