Mix pubblico e privato nel finanziamento dei servizi sanitari in Australia: opt-out con sussidi aggiustati per il profilo di rischio degli assicurati?

Australia’s existing health financing arrangements lead to partial duplication in coverage for private health insurance holders. The two options to remove duplication are: 1) allowing individuals to ‘opt-out’ from Medicare either (a) by purchasing private health insurance or (b) by self-insuring via medical savings accounts or other pre-payment arrangements; 2) confining private health insurance to the coverage of supplementary services. This paper argues in favour of option 1(a), and argues that from an efficiency perspective: private health insurance should be fully substitutive of Medicare coverage (i.e. ‘opting-out’ should be allowed); community-rating should be replaced by premium bands; and the 30-40% ad valorem subsidy for private health insurance should be replaced by ex-ante risk-adjusted subsidies.