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Determinants of prepaid systems of healthcare financing: a worldwide country-level perspective

Author

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  • Andrea M. Leiter

    (University of Innsbruck)

  • Engelbert Theurl

    (University of Innsbruck)

Abstract

In this paper we examine determinants of prepaid modes of health care financing in a worldwide cross-country perspective. We use three different indicators to capture the role of prepaid modes in health care financing: (i) the share of total prepaid financing as percent of total current health expenditures, (ii) the share of voluntary prepaid financing as percent of total prepaid financing, and (iii) the share of compulsory health insurance as percent of total compulsory prepaid financing. In the econometric analysis, we refer to a panel data set comprising 154 countries and covering the time period 2000–2015. We apply a static as well as a dynamic panel data model. We find that the current structure of prepaid financing is significantly determined by its different forms in the past. The significant influence of GDP per capita, governmental revenues, the agricultural value added, development assistance for health, degree of urbanization and regulatory quality varies depending on the financing structure we look at. The share of the elderly and the education level are only of minor importance for explaining the variation in a country’s share of prepaid health care financing. The importance of the mentioned variables as determinants for prepaid health care financing also varies depending on the countries’ socio-economic development. From our analysis we conclude that more detailed information on indicators which reflect the distribution of individual characteristics (such as income, family size and structure and health risks) within a country’s population would be needed to gain deeper insight into the decisive determinants for prepaid health care financing.

Suggested Citation

  • Andrea M. Leiter & Engelbert Theurl, 2021. "Determinants of prepaid systems of healthcare financing: a worldwide country-level perspective," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 317-344, September.
    • Handle: RePEc:kap:ijhcfe:v:21:y:2021:i:3:d:10.1007_s10754-021-09301-w
    DOI: 10.1007/s10754-021-09301-w
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    1. Sebastian Kripfganz, 2016. "Quasi–maximum likelihood estimation of linear dynamic short-T panel-data models," Stata Journal, StataCorp LP, vol. 16(4), pages 1013-1038, December.
    2. Hans-Werner Sinn, 1994. "A Theory of the Welfare State," CESifo Working Paper Series 65, CESifo.
    3. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    4. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    5. Hsiao, Cheng & Hashem Pesaran, M. & Kamil Tahmiscioglu, A., 2002. "Maximum likelihood estimation of fixed effects dynamic panel data models covering short time periods," Journal of Econometrics, Elsevier, vol. 109(1), pages 107-150, July.
    6. Richard Cebula, 2006. "A Further Analysis of Determinants of Health Insurance Coverage," International Advances in Economic Research, Springer;International Atlantic Economic Society, vol. 12(3), pages 382-389, August.
    7. Ataguba, John E. & McIntyre, Di, 2018. "The incidence of health financing in South Africa: findings from a recent data set," Health Economics, Policy and Law, Cambridge University Press, vol. 13(1), pages 68-91, January.
    8. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    9. Feyen, Erik & Lester, Rodney & Rocha, Roberto, 2011. "What drives the development of the insurance sector ? an empirical analysis based on a panel of developed and developing countries," Policy Research Working Paper Series 5572, The World Bank.
    10. Fan, Victoria Y. & Savedoff, William D., 2014. "The health financing transition: A conceptual framework and empirical evidence," Social Science & Medicine, Elsevier, vol. 105(C), pages 112-121.
    11. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517, May.
    12. repec:kap:iaecre:v:12:y:2006:i:3:p:382-389 is not listed on IDEAS
    13. Alice Sanwald & Engelbert Theurl, 2015. "Out-of-pocket payments in the Austrian healthcare system - a distributional analysis," Working Papers 2015-05, Faculty of Economics and Statistics, Universität Innsbruck.
    14. Timothy Besley & Masayuki Kudamatsu, 2006. "Health and Democracy," American Economic Review, American Economic Association, vol. 96(2), pages 313-318, May.
    15. Stefan Dercon, 2002. "Income Risk, Coping Strategies, and Safety Nets," The World Bank Research Observer, World Bank, vol. 17(2), pages 141-166, September.
    16. Victoria Fan and William Savedoff, 2014. "The Health Financing Transition: A Conceptual Framework and Empirical Evidence - Working Paper 358," Working Papers 358, Center for Global Development.
    17. Papke, Leslie E. & Wooldridge, Jeffrey M., 2008. "Panel data methods for fractional response variables with an application to test pass rates," Journal of Econometrics, Elsevier, vol. 145(1-2), pages 121-133, July.
    18. Oecd, 2004. "Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems," Financial Market Trends, OECD Publishing, vol. 2004(2), pages 125-197.
    19. Miguel Gouveia, 1996. "The public sector and health care," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 3(3), pages 329-349, July.
    20. Feigl, Andrea B. & Ding, Eric L., 2013. "Evidenced Formal Coverage Index and universal healthcare enactment: A prospective longitudinal study of economic, social, and political predictors of 194 countries," Health Policy, Elsevier, vol. 113(1), pages 50-60.
    21. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    22. Francesca Colombo & Nicole Tapay, 2004. "Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems," OECD Health Working Papers 15, OECD Publishing.
    23. World Health Organization & World Bank, 2017. "Tracking Universal Health Coverage," World Bank Publications - Books, The World Bank Group, number 29042, December.
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    More about this item

    Keywords

    Health care financing; Prepaid health care financing systems; Out-of-pocket payments; Panel data analysis;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • C33 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Models with Panel Data; Spatio-temporal Models

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