Research
PUBLISHED ARTICLES
Private health insurance in universal public healthcare system: the role of healthcare provision in Finland (Health Policy, 2023)
Abstract: Voluntary private health insurance (VPHI) has gained popularity in universal public healthcare systems. We studied how the local provision of healthcare services contributed to the VPHI take-up in Finland. Nationwide register data from a Finnish insurance company was aggregated to the local level and augmented with high-quality data on public and private primary care providers. Controlling for sociodemographic characteristics, we found that the private healthcare provision explained the VPHI take-up more than public healthcare provision. The VPHI take-up was negatively associated with distance to the nearest private clinic, while the associations with distance to public health stations were statistically weak. Fees and co-payments of healthcare services were not associated with the insurance take-up, meaning that the geographical closeness of providers explained the take-up more than the price of services. In addition, we found that the VPHI take-up was higher when local employment, income, and education levels were higher, and that sociodemographic characteristics were more important in explaining the VPHI take-up than the local healthcare provision. The results were similar for adults and children.
Code for retrieving the open source data: https://drive.google.com/file/d/1IkdVL9cs8U1HlDwkOeZS_yovLP-BkDt9/view?usp=share_link
WORKING PAPERS
Hospital Choice and Patient Outcomes: Evidence from Regional Choice Reform (with Tanja Saxell, Liisa Laine, Luigi Siciliani, and Mika Kortelainen)
Abstract: We investigate the effects of introducing patient choice and competition among public hospitals. We use comprehensive administrative data and a simple difference-in-differences approach resulting from a regional choice reform in Finland. We complement this analysis of reform's overall effects by evaluating the marginal effects of competition using the variation in treatment intensity based on the pre-reform market structure. We find that the reform affected patients' care seeking patterns and waiting times, but had little impact on quality of care or length of stay in hospitals. Surprisingly, large teaching hospitals attracted more patients and concentration in their markets increased.
WORK IN PROGRESS
Overuse of medical imaging and effects of payer-provider integration
Abstract: I study whether privately owned clinics overuse medical imaging and whether payer-provider integration can mitigate potential overuse. I employ administrative insurance claims data from a major Finnish insurance company and exploit the market entries of clinics owned by the company. The underlying assumption is that the insurance company’s own clinics had weaker incentives to overuse imaging than other privately owned clinics because of payer-provider integration. Instead, the company's own clinics had the incentive to underuse imaging, although they were limited in doing so because patients were free to choose any other clinic in the country without financial consequences. Comparing all insured patients in cities with and without market entry, I find that private clinics overused radiography and ultrasound imaging when diagnosing accident patients. In turn, the more expensive computed tomography (CT) and magnetic resonance imaging (MRI) were underused, probably reflecting a lack of imaging capacity in the private clinics. The results show that in some cases, payer-provider integration can mitigate overuse in private healthcare without limiting patients' provider choice, although it should not be considered a panacea.
PRE-PHD WORK
Working time convergence in Europe: findings from 1995–2015
The Finnish Economic Policy Council Report 2016: Chapter 3 (with Teemu Lyytikäinen & Jukka Pirttilä)
https://talouspolitiikanarviointineuvosto.fi/en/reports/report-2016/