Submission Date


Document Type



International Relations


Rebecca Evans

Committee Member

Johannes Karreth

Committee Member

Lauren Wynne

Department Chair

Rebecca Evans

Project Description

While European countries have improved health outcomes through universal healthcare systems (UHC), they also face pressures to contain the high cost of these systems. In order to control expenses, governments have reduced services covered under UHC and increased co-payments. Voluntary health insurance (VHI) can help cover gaps in publicly financed health coverage, but this is not affordable for all. Since people with higher socioeconomic status are more likely to have VHI and medical providers are incentivized to prioritize people with VHI, VHI tends to exacerbate inequalities in access to health care. Similarly, high out-of-pocket costs worsen healthcare. This research focuses on the relationship between VHI and health outcomes for both men and women in UHC systems within the OECD. Qualitative analysis of healthcare systems in Latvia, Poland, Sweden, and the Netherlands shows that countries with higher rates of participation in voluntary private insurance experience higher gender inequality in health outcomes than those with lower rates of participation. Empirical analysis of the effect of voluntary health insurance on differences in infectious disease rates and non-communicable disease rates by gender, and maternal mortality throughout the OECD shows no clear significant relationship between health outcomes and VHI. Findings from this research suggest that health outcomes and inequalities can be improved by reducing reliance on out-of-pocket costs and addressing socioeconomic inequalities, including gender inequality, through greater public coverage.