Voluntary health insurance (VHI) was associated with lower frailty scores and a reduced risk of frailty onset among Europeans aged 50 and older, but may also increase health inequalities if not integrated into a wider public health strategy.
VHI coverage was 37% at baseline among Europeans aged 50 and older and increased across survey waves, with marked heterogeneity by country of residence and income quartile.
VHI was associated with significantly lower frailty scores in mixed effects linear regression analyses.
VHI was associated with a reduced risk of frailty onset in Cox proportional hazards regression analyses.
The association between VHI and lower frailty scores was strongest in the lowest income quartile (Q1), suggesting a differential effect by socioeconomic status.
Frailty affects a substantial proportion of older Europeans, with 5.8–27.3% of those aged ≥65 classified as frail and up to 50.9% as pre-frail.
VHI may widen health inequalities because it functions as an out-of-pocket expense that lower-income groups are less able to afford, potentially weakening the public health system.
This research suggests that having voluntary health insurance (VHI) — private coverage people pay for on top of public health systems — is linked to better frailty outcomes among adults aged 50 and older across 17 European countries. Using data from nearly 192,000 people surveyed between 2013 and 2022, the study found that people with VHI had lower frailty scores overall and were about 14% less likely to develop frailty over the follow-up period compared to those without VHI. The protective effect appeared particularly strong in Spain and in lower- and middle-income groups, suggesting VHI may help fill gaps left by public systems for some people. However, the findings also highlight a potential downside: because VHI requires out-of-pocket payments, people with lower incomes are less likely to be able to afford it. This means the very people who might benefit most from additional health coverage — those with fewer resources — are often the ones least able to access it. As European governments continue to cut public health spending and VHI becomes more widespread, the gap between those who can and cannot afford supplemental insurance may widen, potentially deepening health inequalities among older adults. This research suggests that policymakers should be cautious about relying on VHI as a solution to gaps in public healthcare. While VHI appears to offer some protection against frailty, its benefits are unevenly distributed. The authors argue it should be integrated into a broader public health strategy rather than treated as a market-driven add-on, in order to avoid further eroding universal health coverage and worsening inequalities among aging populations.
Sorrentino M, Uejima Y, Affinito G, Montuori P, Palladino R. (2026). The role of voluntary health insurance in frailty onset and progression among older and aging European adults: a survival analysis, 2013-2022.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1880660