PFM Articles 
Why Some People Go Private and Others Do Not: Supplementary Health Insurance in Spain
JOAN COSTA AND JOAN ROVIRA
PFM, Vol. 5 No. 4,
(2005)
Although the National Health System (NHS) is the main healthcare financing body in Spain, an
increasing share of the population ‘goes private’ by obtaining supplementary private healthcare
insurance (PHI). Qualitative research is very limited and empirical studies hardly ever provide us
with what lies behind the figures. This paper seeks to examine qualitative and quantitative
evidence on the individual’s motives for the purchase of PHI. We undertook two focus groups
together with a representative survey containing open–ended and closed questions among a
sample of the Catalan population. Our findings indicate a high degree of heterogeneity in the
motives for going private, ranging from the already acknowledged ‘quality motive’ to simple
tradition. A certain share of the population reveals ‘captivity’ and satisfaction towards the NHS,
as well as being unable to afford private alternatives. Furthermore, risk aversion and income was
significantly higher for those purchasing PHI.
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