Determinants of health plan enrollment in Brazil

Abstract

Objective: To analyze the determinants of enrollment in private health plans in Brazil, examining how socioeconomic, demographic, and health-related characteristics influence the likelihood that an individual is a beneficiary of supplementary health insurance. Methods: A quantitative and explanatory approach is adopted, based on microdata from the 2019 National Health Survey (PNS), conducted by the Brazilian Institute of Geography and Statistics (IBGE). A logistic regression model (Logit) is applied to estimate the marginal effects of the explanatory variables on the probability of enrolling in a private health plan. Results: The findings indicate that income, educational attainment, and formal employment significantly increase the probability of having private health insurance, highlighting the central role of employer-sponsored plans in private coverage. Regional disparities are also observed, with a lower probability of enrollment in the North and Northeast regions of Brazil. Conclusion: The evidence suggests that the supplementary health market reproduces socioeconomic and territorial inequalities in access to healthcare, while also pointing to potential adverse selection effects, as individuals with chronic diseases show a higher likelihood of enrolling in private plans, possibly reflecting both greater healthcare needs and better access to diagnosis within the private sector.