Private health insurance (PHI) plays a limited role in the health system, accounting for roughly 1 percent of total health spending in 2009. Approximately 15 percent of the population has some form of PHI, generally to cover services excluded under the SSN, to benefit from a higher standard of comfort and privacy in hospital facilities, and to have wider choice among public and private providers. Some PHI policies also cover copayments for privately provided services, or provide compensation during hospitalization, with patients receiving a fixed sum per day. Since the Italian SSN does not allow members to opt out of the system and seek only private care, substitutive insurance does not exist. PHI is provided both by mutual associations (distinguished by their nonprofit status) and by commercial (for-profit) companies, with very few (0.8%) specializing in health care insurance only. Approximately 74 percent of policies are purchased by individuals, while the remaining 26 percent are purchased by groups. In 1999, increased tax relief was established for PHI contributions.