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The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching

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  • Antonio Trujillo

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  • Jorge Portillo
  • John Vernon
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    Abstract

    This paper evaluates the impact of Colombia’s subsidized health insurance program (SUBS) on medical care utilization. Colombia’s SUBS program is a demand-side subsidy intended for low-income families, where the screening of beneficiaries takes place in decentralized locations across the country. Due to the self-selection problems associated with non-experimental data, we implement Propensity Score Matching (PSM) methods to measure the impact of this subsidy on medical care utilization. By combining unique household survey data with community and regional data, we are able to compute propensity scores in a way that is consistent with both the local government’s decision to offer the subsidy, and with the individual’s decision to accept the subsidy. Although the application of PSM using these rich datasets helps to achieve a balance between the treatment and control groups along observable dimensions, we also present instrumental variable estimates to control for the potential endogeneity of program participation. Using both methods, we find that Colombia’s subsidized insurance program greatly increased medical care utilization among the country’s poor and uninsured. This evidence supports the case for other Latin American countries implementing similar subsidy programs for health insurance for the poor. Copyright Springer Science + Business Media, Inc. 2005

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    File URL: http://hdl.handle.net/10.1007/s10754-005-1792-5
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    Bibliographic Info

    Article provided by Springer in its journal International Journal of Health Care Finance and Economics.

    Volume (Year): 5 (2005)
    Issue (Month): 3 (September)
    Pages: 211-239

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    Handle: RePEc:kap:ijhcfe:v:5:y:2005:i:3:p:211-239

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    Web page: http://www.springerlink.com/link.asp?id=106603

    Related research

    Keywords: medical care use; health insurance program evaluation; propensity score; colombia;

    References

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    1. Petra E. Todd & Jeffrey A. Smith, 2001. "Reconciling Conflicting Evidence on the Performance of Propensity-Score Matching Methods," American Economic Review, American Economic Association, vol. 91(2), pages 112-118, May.
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    3. Heckman, James J & Ichimura, Hidehiko & Todd, Petra E, 1997. "Matching as an Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," Review of Economic Studies, Wiley Blackwell, vol. 64(4), pages 605-54, October.
    4. Jyotsna Jalan & Martin Ravallion, 2000. "Estimating the Benefit Incidence of an Antipoverty Program by Propensity Score Matching," Econometric Society World Congress 2000 Contributed Papers 0873, Econometric Society.
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    6. LaLonde, Robert J, 1986. "Evaluating the Econometric Evaluations of Training Programs with Experimental Data," American Economic Review, American Economic Association, vol. 76(4), pages 604-20, September.
    7. Antonio J. Trujillo, 2003. "Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia," Health Economics, John Wiley & Sons, Ltd., vol. 12(3), pages 231-246.
    8. Sascha O. Becker & Andrea Ichino, 2002. "Estimation of average treatment effects based on propensity scores," Stata Journal, StataCorp LP, vol. 2(4), pages 358-377, November.
    9. Juan Jose Diaz & Sudhanshu Handa, 2006. "An Assessment of Propensity Score Matching as a Nonexperimental Impact Estimator: Evidence from Mexico’s PROGRESA Program," Journal of Human Resources, University of Wisconsin Press, vol. 41(2).
    10. Barbara Sianesi, 2001. "Propensity score matching," United Kingdom Stata Users' Group Meetings 2001 12, Stata Users Group, revised 23 Aug 2001.
    11. Moffitt, Robert, 1983. "An Economic Model of Welfare Stigma," American Economic Review, American Economic Association, vol. 73(5), pages 1023-35, December.
    12. Sianesi, Barbara, 2001. "An evaluation of the active labour market programmes in Sweden," Working Paper Series 2001:5, IFAU - Institute for Evaluation of Labour Market and Education Policy.
    13. Conning, Jonathan & Kevane, Michael, 2002. "Community-Based Targeting Mechanisms for Social Safety Nets: A Critical Review," World Development, Elsevier, vol. 30(3), pages 375-394, March.
    14. Friedlander, Daniel & Robins, Philip K, 1995. "Evaluating Program Evaluations: New Evidence on Commonly Used Nonexperimental Methods," American Economic Review, American Economic Association, vol. 85(4), pages 923-37, September.
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    Cited by:
    1. Sosa-Rubí, Sandra G. & Galárraga, Omar & Harris, Jeffrey E., 2009. "Heterogeneous impact of the "Seguro Popular" program on the utilization of obstetrical services in Mexico, 2001-2006: A multinomial probit model with a discrete endogenous variable," Journal of Health Economics, Elsevier, vol. 28(1), pages 20-34, January.
    2. César P. Bouillon & Luis Tejerina, 2006. "Do We Know What Works?: A Systematic Review of Impact Evaluations of Social Programs in Latin America and the Caribbean," IDB Publications 80443, Inter-American Development Bank.
    3. Nolan, Anne, 2006. "Evaluating the Impact of Eligibility for Free Care on the Use of GP Services in Ireland: A Difference-in-Difference Matching Approach," Papers HRBWP25, Economic and Social Research Institute (ESRI).
    4. Chu, Xueling & Chen, Qihui & Fang, Xiangming, 2013. "Can National Health Insurance Programs Improve Health Outcomes?—Re-Examining the Case of the New Cooperative Medical Scheme in Rural China," 2013 Annual Meeting, August 4-6, 2013, Washington, D.C. 150488, Agricultural and Applied Economics Association.
    5. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    6. Alejandro Arrieta & Ariadna García Prado & Giota Panopoulou, 2012. "Enrolling the Self-Employed in Mandatory Health Insurance in Colombia: are we missing other factors?," Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra 1213, Departamento de Economía - Universidad Pública de Navarra.
    7. Cheung, Diana & Padieu, Ysaline, 2011. "Impact of Health Insurance on Consumption and Saving Behaviours: Evidence from Rural China," Proceedings of the German Development Economics Conference, Berlin 2011 18, Verein für Socialpolitik, Research Committee Development Economics.
    8. Wagstaff, Adam, 2007. "Health insurance for the poor : initial impacts of Vietnam's health care fund for the poor," Policy Research Working Paper Series 4134, The World Bank.
    9. Machado, Matilde Pinto & Pita Barros, Pedro Luis & Sanz-de-Galdeano, Anna, 2006. "Moral Hazard and the Demand for Health Services: A Matching Estimator Approach," CEPR Discussion Papers 5488, C.E.P.R. Discussion Papers.
    10. Acharya, Arnab & Vellakkal, Sukumar & Taylor Fiona & Masset Edoardo & Satija, Ambika & Burke, Margaret & Ebrahim, Shah, 2013. "The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review," Policy Research Working Paper Series 6324, The World Bank.
    11. Sparrow, Robert & Suryahadi, Asep & Widyanti, Wenefrida, 2013. "Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme," Social Science & Medicine, Elsevier, vol. 96(C), pages 264-271.
    12. Andrés Ramírez Hassan & Johnatan Cardona Jimenez & Ramiro Cadavid Montoya, 2011. "The impact of subsidized health insurance on the poor in Colombia: Evaluating the case of Medellin," DOCUMENTOS DE TRABAJO CIEF 010602, UNIVERSIDAD EAFIT.
    13. Adam Wagstaff, 2010. "Estimating health insurance impacts under unobserved heterogeneity: the case of Vietnam's health care fund for the poor," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 189-208.
    14. Omar Galárraga & Sandra Sosa-Rubí & Aarón Salinas-Rodríguez & Sergio Sesma-Vázquez, 2010. "Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico," The European Journal of Health Economics, Springer, vol. 11(5), pages 437-447, October.
    15. Antonio Trujillo & Fernando Ruiz & John Bridges & Jeannette Amaya & Christine Buttorff & Angélica Quiroga, 2012. "Understanding consumer preferences in the context of managed competition," Applied Health Economics and Health Policy, Springer, vol. 10(2), pages 99-111, March.
    16. Meliyanni Johar, 2007. "The Impact of the Indonesian Health Card Program: A Matching Estimator Approach," Discussion Papers 2007-30, School of Economics, The University of New South Wales.

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