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Uvod: V Sloveniji imamo od leta 1992 razvit sistem socialne varnosti, ki temelji na načelih obveznega zdravstvenega zavarovanja in na načelih prostovoljnega zdravstvenega zavarovanja. Zdravstveno zavarovanje v Sloveniji je urejeno z Zakonom o zdravstvenem varstvu in zdravstvenem zavarovanju. Sestavljeno je iz osnovnega in dodatnega zavarovanja (Štruc, 2010). V Sloveniji se zdravstvena varnost prebivalstva zagotavlja z javnim sistemom obveznega zdravstvenega zavarovanja, ki ga izvaja ZZZS. Manjši delež zdravstvenih izdatkov se pokriva tudi iz zasebnih sredstev (Fakin, 2012). Namen: Namen magistrskega dela je, da s pomočjo pregleda in analize strokovne in znanstvene literature predstavimo glavne značilnosti dela medicinske sestre v zavarovalništvu oziroma v zdravstveni zavarovalnici. Metode dela: Pri izdelavi magistrskega dela bomo uporabili kvalitativno metodo in deskriptivno raziskovalno metodo s kritičnim pregledom, zbiranjem in analiziranjem domače ter tuje literature. Uporabljena bo literatura iz podatkovnih baz CHINAL, MEDLINE in COBISS.SI. Uporabili bomo literaturo iz obdobja od leta 2010 do leta 2020. Rezultati: S kvalitativno analizo vsebine smo v raziskavi opredelili tri glavne teme, kjer smo poiskali odgovore na zastavljena raziskovalna vprašanja: delo diplomirane medicinske sestre v zdravstveni zavarovalnici, delovne izkušnje in dodatna prostovoljna zdravstvena zavarovanja. Ugotovili smo, da diplomirane medicinske sestre, ki so dlje časa zaposlene v zdravstveni zavarovalnici, izvajajo vse naloge, od najlažjih do zahtevnejših primerov. V primerjavi z obravnavo pacienta v bolnišnici ali v kakšni drugi zdravstveni ustanovi so delovne naloge diplomirane medicinske sestre pri zavarovalniški obravnavi zavarovanca zelo drugačne. Zaposlovanje diplomiranih medicinskih sester je po mnenju vseh intervjuvancev za zdravstveno zavarovalnico velika prednost. Razprava in zaključek: Zdravstveno zavarovanje zagotavlja socialno in zdravstveno varnost v primeru poškodbe ali bolezni. Zdravstvene zavarovalnice sledijo spremembam navad, stališč, vrednost in vedenju prebivalstva ter zahtevam po posameznih vrstah zdravstvenih zavarovanj. V prihodnosti bodo z razvojem novosti tudi diplomiranim medicinskim sestram dodeljene nove naloge v zdravstveni zavarovalnici skozi celoten proces zavarovanja, kot so na primer sprejem zavarovanca v zavarovanje, trženje zavarovanja, za zdravstveno-izobraževalne programe glede ozaveščanja zavarovancev ter za podaljševanje in obravnavo zavarovalnega primera in zdravstvenega zavarovanja. Introduction: In Slovenia, we have developed a social security system since 1992, which is based on the principles of compulsory health insurance and the principles of voluntary health insurance. Health insurance in Slovenia is regulated by the Health Care and Health Insurance Act. It consists of basic and supplementary insurance (Štruc, 2010). In Slovenia, the health security of the population is ensured by the public system of compulsory health insurance implemented by the HIIS. A smaller share of medical expenses is also covered from private funds (Fakin, 2012). Purpose: The purpose of the master's thesis is to present the main characteristics of the work of a nurse in insurance or health insurance through a review and analysis of professional and scientific literature. Methods of work: In the preparation of the master's thesis we will use a qualitative method and a descriptive research method with a critical review, collection and analysis of domestic and foreign literature. Literature from CHINAL, MEDLINE and COBISS.SI databases will be used. We will use the literature from the period from 2010 to 2020. Results: During the qualitative analysis of the content, 3 main topics were formed through the research, which serve as answers to the research questions: the work of a graduate nurse in a health insurance company, work experience and additional voluntary health insurance. Graduate nurses who have been employed by a health insurance company for a long time perform all tasks, from the easiest to the most demanding cases. The treatment of an insured person is very different compared to the treatment of a patient in a hospital or other medical institution. According to all interviewees, hiring graduate nurses is a great advantage for the insurance company. Discussion and conclusion: Health insurance provides social and health security at the time of injury or illness. Health insurance companies follow changes in the habits, attitudes, values and, of course, the behavior of the population and the requirements for individual types of health insurance. In the future, with the development of innovations, nurses will also be assigned new tasks in the health insurance company throughout the entire insurance process, such as admission of the insured to insurance, marketing of insurance, for health education programs regarding the awareness of the insured and, of course, for the extension and treatment of the insurance case and health insurance.

Vse bolj pogosta doplačevanja za zdravila, obiski zasebnih specialistov zaradi dolgih čakalnih vrst in težje dostopnosti do zdravnikov ter občutek neslišanosti bolnika vplivajo na nezadovoljstvo z zdravstvenim sistemom v Sloveniji. Večkrat se postavlja vprašanje, zakaj se javno zdravstvo plačuje, če pa postaja vse bolj profitna dejavnost. Namen diplomskega dela je predstaviti sistem zdravstvenega varstva v Sloveniji, predvsem pa se osredotočiti na dopolnilno zdravstveno zavarovanje. V teoretičnem delu je podrobneje predstavljeno dopolnilno zdravstveno zavarovanje, kako se je razvijalo skozi zgodovino in njegove ključne značilnosti, saj je le–to tisto, ki je v zadnjem času postalo glavna tarča kritik. Prikazani so aktualna problematika in predlogi reform trenutnega sistema. V empiričnem delu je z analizo anketnega vprašalnika preučeno zadovoljstvo uporabnikov z dopolnilnim zdravstvenim zavarovanjem in kateri dejavniki glede na spol (moški/ženski) in starost vplivajo na izbiro zavarovalnice. Ugotovili smo, da se uporabniki v večini ne strinjajo s plačevanjem dopolnilnega zdravstvenega zavarovanja in da bi ga bilo potrebno ukiniti. Nezadovoljni so z visokimi cenami zavarovalnih premij in dejstvom, da so le-te enake za vse, ne glede na dohodek posameznika. Ravno tako jih motijo doplačevanje za zdravila in dolge čakalne dobe. Ugotovili smo, da cena glede na spol ne vpliva na izbiro zavarovalnice. V diplomskem delu so prikazane tudi prednosti in slabosti dopolnilnega zdravstvenega zavarovanja. Z diplomskim delom je dan vpogled v dopolnilno zdravstveno zavarovanje in s tem boljše razumevanje le-tega. Zakaj torej prihaja do višanja cen zavarovalnih premij in zmanjšanja obsega pravic ter katere so možnosti za spremembo trenutnega sistema oziroma za ukinitev samega zavarovanja. Increasingly frequent co-payments for medicines, visits to private specialists, due to long queues and more difficult accesss to doctors, and the feeling of not being heard as a patient affect dissatisfaction with the health care system in Slovenia. The question is why we need to pay for public health care if it is becoming profitable activity. The purpose of the diploma thesis is to present the health care system in Slovenia, and above all to focus on supplementary health insurance. In the theoretical part, with the help of the descriptive method, supplementary health insurance is presented in more detail, how it has developed through history and its key features. Current issues and proposals for reforms of the current system are presented. In the empirical part, the analysis of the questionnaire analyzes the satisfaction of users with supplementary health insurance and whether the price of insurance premiums by gender (male / female) affects the choice of insurance company. We found that the majority of users do not agree with the payment of supplementary health insurance and that it should be abolished. They are dissatisfied with the high prices of insurance premiums and the fact that they are the same for everyone, regardless of an individual's income. They are also bothered by overpayments for medicines and long waiting times. We also found that price by gender does not affect the choice of insurance company. The SWOT matrix shows the advantages, disadvantages, opportunities and dangers of supplementary health insurance. The diploma thesis provides an insight into supplementary health insurance and thus a better understanding of it. So why is there an increase in the price of insurance premiums and a reduction in the scope of rights, and what are the possibilities for changing the current system or abolishing the insurance itself.

Resumo O presente estudo objetivou comparar as mudanças nos padrões de cobertura por planos privados de saúde entre servidores públicos, militares e demais trabalhadores no Brasil e verificar se a vinculação a planos de saúde repercute nas respectivas prevalências autorreferidas de Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM) no país. Para isso, foram utilizados os trabalhadores do setor público (federal, estadual, municipal ou militar) e, outros trabalhadores, com ≥ 18 anos de idade incluídos na Pesquisa Nacional de Amostra de Domicílios dos anos de 1998, 2003, 2008 e na Pesquisa Nacional de Saúde de 2013. Observou-se que ao longo dos anos de estudo, os servidores públicos civis e militares do Brasil apresentaram elevada e crescente proporção de adesão aos planos privados de saúde em relação aos demais trabalhadores. As prevalências de HAS e DM sempre foram maiores e cresceram entre os servidores com planos de saúde do que entre os sem planos. O status diferenciado aos servidores públicos e militares, no que se refere ao duplo acesso aos serviços públicos e privados de saúde, refletiu-se nas crescentes prevalências autorreferidas de HAS e DM, aumentando as iniquidades em saúde diante de um sistema público constituído de modo universal e equânime.

V diplomskem projektu smo pojasnili urejenost zdravstvenega varstva v Sloveniji, podrobneje smo obravnavali področje dodatnega in dopolnilnega zdravstvenega zavarovanja. Želeli smo prikazati njuno vlogo in pomen v naši državi ter navesti razloge, zakaj se bosta le-ta v prihodnosti še povečevala. V nadaljevanju smo predstavili zavarovalnice, ki ponujajo takšna zavarovanja na zavarovalniškem trgu v Sloveniji in opravili podroben pregled ponudbe zavarovalnih produktov, ki jih nudijo ter se seznanili z novostmi, s katerimi se dandanes srečujemo na omenjenem področju. Na podlagi pridobljenih statističnih podatkov smo predstavili prihodke premij in odhodke za škode zavarovalnic iz naslova dopolnilnih in dodatnih zdravstvenih zavarovanj, pri katerih smo izločili inflacijske vplive. Navedli smo tudi podatke o številu zavarovancev in o premijah, ki jih morajo zavarovanci plačevati za zagotovitev pravic. V zadnjem delu raziskovalnega dela smo predstavili značilnosti dodatnega in dopolnilnega zdravstvenega zavarovanja v nekaterih tujih državah, ki so članice Evropske unije in so tipični predstavniki omenjenih zavarovanj. In the diploma project, we explained the regulation of health care in Slovenia, more precisely the field of complementary and supplementary health insurance. By making a research, we wanted to show their role and importance in our country and to state the reasons why their importance will only increase in the future. Furthermore, we presented insurance companies offering such insurance on the insurance market in Slovenia and carried out a detailed overview of the offer of insurance products offered by them. Also, we have noted novelties, which are now encountered in the field of health care insurances. On the basis of the statistical data we have presented revenue premiums and insurance claims incurred from supplementary and complementary health insurance, in which we excluded inflationary effects. We have also listed information on the number of insured and the premiums that policyholders need to pay in order to secure rights. In the last part of the research, we presented the features of complementary and supplementary health insurance in some foreign countries, which are members of the European Union and are typical representatives of the above mentioned insurance.

Most developed nations provide generous coverage of care services, using either a tax financed healthcare system or social health insurance. Such systems pursue efficiency and equity in care provision. Efficiency means that expenditures are minimized for a given level of care services. Equity means that individuals with equal needs have equal access to the benefit package. In order to limit expenditures, social health insurance systems explicitly limit their benefit package. Moreover, most such systems have introduced cost sharing so that beneficiaries bear some cost when using care services. These limits on coverage create room for private insurance that complements or supplements social health insurance. Everywhere, social health insurance coexists along with voluntarily purchased supplementary private insurance. While the latter generally covers a small portion of health expenditures, it can interfere with the functioning of social health insurance. Supplementary health insurance can be detrimental to efficiency through several mechanisms. It limits competition in managed competition settings. It favors excessive care consumption through coverage of cost sharing and of services that are complementary to those included in social insurance benefits. It can also hinder achievement of the equity goals inherent to social insurance. Supplementary insurance creates inequality in access to services included in the social benefits package. Individuals with high incomes are more likely to buy supplementary insurance, and the additional care consumption resulting from better coverage creates additional costs that are borne by social health insurance. In addition, there are other anti-redistributive mechanisms from high to low risks. Social health insurance should be designed, not as an isolated institution, but with an awareness of the existence—and the possible expansion—of supplementary health insurance.

Resumo O presente estudo objetivou comparar as mudanças nos padrões de cobertura por planos privados de saúde entre servidores públicos, militares e demais trabalhadores no Brasil e verificar se a vinculação a planos de saúde repercute nas respectivas prevalências autorreferidas de Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM) no país. Para isso, foram utilizados os trabalhadores do setor público (federal, estadual, municipal ou militar) e, outros trabalhadores, com ≥ 18 anos de idade incluídos na Pesquisa Nacional de Amostra de Domicílios dos anos de 1998, 2003, 2008 e na Pesquisa Nacional de Saúde de 2013. Observou-se que ao longo dos anos de estudo, os servidores públicos civis e militares do Brasil apresentaram elevada e crescente proporção de adesão aos planos privados de saúde em relação aos demais trabalhadores. As prevalências de HAS e DM sempre foram maiores e cresceram entre os servidores com planos de saúde do que entre os sem planos. O status diferenciado aos servidores públicos e militares, no que se refere ao duplo acesso aos serviços públicos e privados de saúde, refletiu-se nas crescentes prevalências autorreferidas de HAS e DM, aumentando as iniquidades em saúde diante de um sistema público constituído de modo universal e equânime. Abstract The scope of this paper was to compare the changes in coverage patterns by health insurance plans among public servants, the military and other employees in Brazil and verify if the purchase of such health plans is reflected in the respective self-reported prevalence of Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM) in the country. For this purpose, workers in the public sector (federal, state, municipal or military) and other workers aged ≥18 who were included in the 1998, 2003 and 2008 campaigns of the National Household Sample Survey (PNAD) and in the 2013 National Survey were studied. Over the years of the study, it was observed that Brazil’s public service employees, both civilian and military, have presented a high and increasing proportion of health insurance purchase compared to other workers. The prevalence of SAH and DM has always been higher among employees with health insurance. The special status of public servants and the military as regards the double access to both public and private healthcare systems is reflected in the increasing self-reported prevalence of SAH and DM, increasing health inequities in a public health system that was constituted in a universal and equitable way.

Zaradi demografskih in družbenih sprememb ter hkrati zaradi omejevanja javne porabe zaradi finančne krize, ki je prizadela Evropo po letu 2008, se (javni) sistemi zdravstvenega varstva v mnogih državah na svetu soočajo z velikimi finančnimi negotovostmi, ki imajo pomemben vpliv na doseženo raven dostopnosti in kakovost zdravstvenih storitev (Sklepi Sveta o skupnih vrednotah in načelih zdravstvenih sistemov Evropske unije, 2006). Številni sistemi ne uspejo zajeziti rasti stroškov, finančni pritiski pa vse bolj otežujejo zagotavljanje socialnega in zdravstvenega varstva v posameznih državah v Evropi in izven njenih meja (EK, 2011). V Sloveniji se že od nastopa globalne ekonomske krize soočamo z velikimi negotovostmi ne zgolj na področju finančne vzdržnosti sistema zdravstvenega varstva, temveč tudi na drugih področjih družbenega delovanja in razvoja. Kriza je razkrila številne strukturne pomanjkljivosti v državi, pogoste odmike je zaslediti v obstoječi regulativi, z vidika finančne vzdržnosti javnih sistemov in obstoja sistema blaginje pa je vse prej kot ugodna tudi demografska struktura in napovedi za prihodnost. V nalogi smo predstavili trenutno stanje in gibanje trendov posameznih postavk, ki so neposredno povezane z zagotavljanjem zadostnih in stabilnih virov financiranja sistema zdravstvenega varstva (javni in zasebni viri financiranja, davki in socialni prispevki) ter v okviru le-teh proučili obseg solidarnosti in socialne pravičnosti. Na osnovi teoretičnih spoznanj, primerjalnih podatkov, kvalitativne analize in matematičnih izračunov smo v zaključnem delu naloge ocenili vpliv trenutne ureditve na izbrane kazalnike solidarnosti in socialne pravičnosti (to so univerzalen dostop, progresivnost in proporcionalnost, pokritost za osnovno košarico pravic, stopnja delitve stroškov različnih družbenih skupin v sistemu obveznega zdravstvenega zavarovanja, višina premije pri dopolnilnem zdravstvenem zavarovanju, delež neposrednih plačil iz žepa) ter nakazali možnosti nadaljnjega razvoja. Financiranje sistema zdravstvenega varstva v Sloveniji ni pravično in vpliva na zmanjšanje načela solidarnosti. Breme financiranja sistema prevzema predvsem aktivna populacija, obstoječa ureditev ob predpostavki demografskih sprememb pa tudi ne zagotavlja finančne vzdržnosti sistema na dolgi rok. Kljub trenutnim fiskalnim omejitvam, je nujno potrebno pretehtati javne prihodke in znotraj le-teh iskati stabilne vire za financiranje sistema zdravstvenega varstva, ki bodo zadostili predvsem zdravstvenim potrebam prebivalstva kot tudi številnim drugim zahtevam v sistemu in izven njega. Da bi zagotovili solidarnost in socialno pravičnost na ravni zbiranja sredstev za financiranje sistema zdravstvenega varstva so potrebne usklajene politike na vseh ključnih področjih družbenega delovanja in razvoja kot tudi usklajeno delovanje vseh ključnih funkcij znotraj sistema zdravstvenega varstva, ki so medsebojno povezane in soodvisne. Dostopnost do učinkovitih zdravstvenih storitev in zaščita pred zdravstvenimi in/ali dohodkovnimi šoki se lahko uresničuje zgolj s sodelovanjem in podporo, skrbno načrtovanimi procesi in aktivnostmi, visoko pokritostjo za definiran obseg storitev (standard, obseg in cene zdravstvenih storitev bi morale biti regulirane) ter transparentno in odgovorno rabo sredstev na vseh nivojih delovanja (razdelitev sredstev glede na dejanski obseg opravljenih storitev z upoštevanjem nagrajevanja za kakovostno opravljeno delo). Zgolj na tak način lahko spodbujamo enakost in pravičnost v sistemu ter izboljšujemo kakovost življenja prebivalcev in prebivalk, ki je pomemben dejavnik blaginje in osrednji cilj družbenega razvoja. of public budget restrictions following the financial crisis that has affected Europe in 2008, (public) healthcare systems in numerous countries around the globe are facing considerable financial uncertainties, which has a significant impact on the achieved level of availability, scope, and quality of healthcare services (Council Conclusions on Common values and principles in European Union Health Systems, 2006). Various systems are struggling to contain cost growth, while financial pressures make it increasingly challenging to ensure social security and healthcare provision in individual states of the EU and beyond (EC, 2011). Since the onset of the global economic crisis, Slovenia has been facing increased instabilities, not only in terms of financial sustainability of the healthcare system but also in other areas of social organisation and development. The crisis has uncovered many structural weaknesses in the country, in existing regulations there are frequent deviations, while in terms of financial sustainability of public systems and of the welfare system, the demographic structure and the predictions for the future are also proving to be less than favourable. The thesis presents the current state and the development of trends of individual items that are directly connected to the provision of sufficient and stable sources of healthcare funding (public and private funding sources, taxes, and social contributions) and, further, examines the scope of solidarity and social fairness in this context. Based on theoretical insights, comparative data, qualitative analysis, and mathematical calculations, the concluding part of the thesis assesses the impact of the current arrangement on selected indicators of solidarity and social fairness (namely, universal access to healthcare, progressivity and proportionality, basket of basic healthcare rights, the cost-sharing rate between different social groups in the compulsory health insurance system, premium levels in supplementary health insurance, rate of direct, out-of-pocket payments) and identifies potential prospects for future development. Healthcare funding in Slovenia is not fair and adversely impacts the principle of solidarity. Considering the demographic and social changes, this threat to the principle of solidarity, which is already becoming the new reality, is expected to continue to grow in the following years. Nevertheless, in current circumstances of fiscal restraint, there is an urgent need for a re-examination of public revenue to find stable resources of financing the (public) healthcare system that will meet healthcare needs of the population as well as respond to numerous other demands in and outside of the system. In order to ensure solidarity and social justice on the level of collecting funds for the healthcare system, we need consistent and coordinated policies in all key areas of social organisation and development as well as coordinated action of all key functions within the healthcare system. This is the only way to build the welfare system, encourage equality and justice within the system, and improve the quality of life for all, which is a major determinant of welfare and the main goal of social development.

Predmet istraživanja ovog rada je ispitivanje utjecaja pretpostavljenih čimbenika na potražnju za dodatnim zdravstvenim osiguranjem. Ispitivanje je provedeno temeljem anketnog upitnika, uzorkom od 151-og ispitanika. Rezultati ispitivanja pokazuju kako osobni dohodak, osobno bogatstvo, cijena police dodatnog zdravstvenog osiguranja, dob, razina obrazovanja, razina sportske aktivnosti i sklonost za drugim oblicima osiguranja utječu na potražnju za dodatnim zdravstvenim osiguranjem. Za ostale analizirane čimbenike spol, učestalost nezdrave prehrane, konzumiranje alkohola, konzumiranje duhanskih proizvoda, rezultati ispitivanja pokazuju kako ne utječu na potražnju za dodatnim zdravstvenim osiguranjem, dok odnos negativne selekcije i potražnje za dodatnim zdravstvenim osiguranjem nije dokazan. The object of this research is examination of factors that influence demand for supplementary health insurance. Research is conducted by questionnaire based on 151 respondents. According to do results, personal income, personal wealth, price of supplementary health insurance, ages, level of education, sports activity and tendency to buying other insurances influence demand for supplementary health insurance. Other analysed factors, gender, freqeuncy of consuming unhealthy food, consuming alcohol, and consuming tobacco don't have influence on demand for supplementary health insurance, and relation between negative selection and demand for supplementary health insurance wasn't confirmed.

This thesis deals with two questions relative to efficiency and fairness in mixed health insurance systems with partial mandatory coverage and voluntary supplementary health insurance (SHI): (i) the inflationary effect of SHI on medical prices; (ii) the fairness of SHI premiums. We set the analysis in the French context and perform empirical analyses on original individual-level data, collected from the administrative claims of a French insurer (MGEN). The sample is made of 99,878 individuals observed from 2010 to 2012. In Chapter 1, we estimate the causal impact of a generous SHI on patients' decisions to consult physicians who balance bill their patients. We find evidence that better coverage contributes to the rise in medical prices. In Chapter 2, we specify individual heterogeneity in moral hazard and consider its possible correlation with coverage choices. We find evidence of selection on moral hazard: individuals who are more likely to ask for coverage exhibit stronger moral hazard. In Chapter 3, results show that when SHI is voluntary, age-based premiums maximize transfers between low and high healthcare users but do not guarantee vertical equity., Cette thèse est consacrée aux systèmes d'assurance maladie mixtes où la couverture publique obligatoire peut être améliorée par une complémentaire santé. Les questions abordées portent sur l'effet inflationniste de la complémentaire sur le prix des soins et sur l'impact de la tarification à l'âge sur les solidarités entre malades et bien portants et entre catégories de revenu. Les analyses empiriques sont réalisées sur données françaises. Cette base de données originale regroupe les consommations de soins de 99,878 affiliés à la MGEN sur la période 2010-2012. Le chapitre 1 estime l'effet causal d'une meilleure couverture sur la consommation de dépassements d'honoraires et démontre l'effet inflationniste de la complémentaire sur le prix des soins. Le chapitre 2 considère l’hétérogénéité de l'impact d'une meilleure couverture sur les dépassements et sa corrélation avec la demande d'assurance. De fait, l’effet inflationniste de la complémentaire est accentué par des effets de sélection. Le chapitre 3 montre que la tarification à l'âge permet de maximiser les transferts entre malades et bien portants au détriment de la solidarité entre hauts et bas revenus.

Zdravstveno osiguranje je vrsta osiguranja o kojemu građani još uvijek nemaju dovoljno znanja i najčešće se poistovjećuje s obveznim zdravstvenim osiguranje. Osim obveznog zdravstvenog osiguranja, na tržištu u Republici Hrvatskoj prisutna su i dobrovoljna zdravstvena osiguranja. Dopunsko zdravstveno osiguranje je podvrsta zdravstvenog osiguranja koje u Republici Hrvatskoj nije zakonom obvezno, ali su ga građani već prepoznali kao nešto što je postalo nužno ugovoriti ukoliko žele smanjiti financijski rizik uslijed nastupa bolesti ili ozljede, odnosno spriječiti iznenadne troškove koji bi mogli dodatno opteretili postojeći budžet kućanstva. Za razliku od dopunskog zdravstvenog osiguranja, dodatno zdravstveno osiguranje je podvrsta zdravstvenog osiguranja koje je građanima manje poznato iako postoji na tržištu Republike Hrvatske već više od 15 godina. Kako su potencijal dodatnog zdravstvenog osiguranja prepoznali osiguratelji kao veliki potencijal, ponuda dodatnog zdravstvenog osiguranja na osigurateljnom tržištu u Republici Hrvatskog je u porastu. Dio građana je već prepoznao prednosti i potencijal ovog oblika osiguranja. Pretpostavka je da je sama cijena police dodatnog zdravstvenog osiguranja jedna od prepreka za ugovaranje police pa istu danas ipak više ugovaraju građani sa boljim imovinskim statusom i/ili građani koji su imali priliku isprobati način korištenja usluga koje takva polica zdravstvenog osiguranja pruža. U ovom diplomskom radu su istraženi motivi koji utječu na ugovaranje police dodatnog zdravstvenog osiguranja te da li zdravstvena ustanova u vlasništvu osiguratelja ima značajnu ulogu kod donošenja odluke o sklapanju ugovora o osiguranju. Health insurance is a type of insurance on which citizens still do not have enough knowledge and most of people identified health insurance with the mandatory health insurance. On health insurance market in Croatia, there are two types of health insurance: mandatory and voluntary health insurance. Complementary health insurance is a subspecies of voluntary health insurance. Citizens have recognized complementary health insurance as something that has become necessary to stipulate if they want to reduce the financial risk due to disease or injury, or to prevent unexpected costs that could further strain on the existing budget household. Supplementary health insurance is a subspecies of the voluntary health insurance is less known to the citizens, despite of its presents on the Croatian market for more than 15 years. Insurance companies recognized the potential of supplementary insurance as a great one and offer of supplementary health insurance products on Croatian market is growing. Part of the citizens had already recognized the advantages and potential of supplementary health insurance. The assumption is that the price of supplementary health insurance is one of the obstacles to contracting of the policy. Citizens with better property status or citizens who had the opportunity to try out a way of using services of supplementary health insurance, contracted most of the supplementary health insurance policies. This thesis explored the motivation for contracting of supplementary health insurance and whether a medical institutions owned by insurer has a significant role in the decision for contraction of insurance.

In this paper we investigate the possible presence of switching costs when consumers are offered the opportunity to change their basic health insurance provider. We focus on the specific case of Switzerland which implemented a pure form of competition in basic health insurance markets. We identify several barriers to switching, namely choice overload, status quo bias, the possession of supplementary contracts for enrollees in bad health, firm's pricing strategies based on providing low price supplementary products, poor regulation of reserves and the limitations of the previous risk-equalization mechanism which left room for risk selection practices., Dans ce papier, nous analysons la présence de coûts de changement (coûts de switching) lorsque les consommateurs ont la possibilité de changer d'assureur pour l'assurance maladie de base. Nous nous intéressons au cas de la Suisse qui a mis en place une forme relativement pure de concurrence en assurance maladie. Nous identifions différents types de coûts de changement : l'excès de choix (en termes de nombre de compagnies présentes sur le marché), le biais de statu quo, la possession d'un contrat d'assurance supplémentaire pour les assurés déclarant un mauvais état de santé, les stratégies tarifaires des firmes qui utilisent l'assurance supplémentaire comme produit d'appel, la mauvaise régulation des réserves des caisses et les limites liées au mécanisme initial de compensation des risques.

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics Despite the fact that public medical care has being heavily subsidized through a statutory national health system there has been a growing number of people who opt to enroll in extra private coverage. Using a two part model to infer the insurance decision and subsequent amount of insurance chosen we found out that people’s decision over private health coverage is not related with their health. The pattern of consumption of medical care that is not available in the public sector and a good socio economic background were found significant modeling the demand for private health insurance.

This paper examines the competition of nonprofit sickness funds in the market for supplementary health insurance. We investigate product quality strategies when quality is costly and the sickness funds are competing for customers. As long as the sickness funds choose the qualities for simultaneously, any equilibrium will be nondifferentiated. Only if total demand is increasing in quality, both sickness funds provide the maximum quality. For decreasing total demand the existence of an equilibrium depends on the consumers' sensitivity. If there is no equilibrium in the simultaneous competition, sequential quality competition leads to a differentiated equilibrium with a first mover advantage.