IDEAS home Printed from https://ideas.repec.org/a/pal/genrir/v47y2022i1d10.1057_s10713-021-00069-0.html
   My bibliography  Save this article

Does free hospitalization insurance change health care consumption of the poor? Short-term evidence from Pakistan

Author

Listed:
  • Simona Helmsmüller

    (Bonn-Rhein-Sieg University of Applied Sciences)

  • Andreas Landmann

    (Friedrich-Alexander University of Erlangen-Nürnberg)

Abstract

We analyze short-term effects of free hospitalization insurance for the poorest quintile of the population in the province of Khyber Pakhtunkhwa, Pakistan. First, we exploit that eligibility is based on an exogenous poverty score threshold and apply a regression discontinuity design. Second, we exploit imperfect rollout and compare insured and uninsured households using propensity score matching. With both methods we fail to detect significant effects on the incidence of hospitalization. Whereas the program did not meaningfully increase the quantity of health care consumed, insured households more often choose private hospitals, indicating a shift towards higher perceived quality of care.

Suggested Citation

  • Simona Helmsmüller & Andreas Landmann, 2022. "Does free hospitalization insurance change health care consumption of the poor? Short-term evidence from Pakistan," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 47(1), pages 238-275, March.
  • Handle: RePEc:pal:genrir:v:47:y:2022:i:1:d:10.1057_s10713-021-00069-0
    DOI: 10.1057/s10713-021-00069-0
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1057/s10713-021-00069-0
    File Function: Abstract
    Download Restriction: Access to full text is restricted to subscribers.

    File URL: https://libkey.io/10.1057/s10713-021-00069-0?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Markus Frölich & Andreas Landmann, 2018. "Effects of Insurance on Child Labour: Ex-Ante and Ex-Post Behavioural Changes," Journal of Development Studies, Taylor & Francis Journals, vol. 54(6), pages 1002-1018, June.
    2. Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, vol. 22(1), pages 31-72, February.
    3. Abhijit Banerjee & Amy Finkelstein & Rema Hanna & Benjamin A. Olken & Arianna Ornaghi & Sudarno Sumarto, 2019. "The Challenges of Universal Health Insurance in Developing Countries: Evidence from a Large-scale Randomized Experiment in Indonesia," NBER Working Papers 26204, National Bureau of Economic Research, Inc.
    4. Alberto Abadie & Guido W. Imbens, 2008. "On the Failure of the Bootstrap for Matching Estimators," Econometrica, Econometric Society, vol. 76(6), pages 1537-1557, November.
    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. Matias D. Cattaneo & Michael Jansson & Xinwei Ma, 2020. "Simple Local Polynomial Density Estimators," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 115(531), pages 1449-1455, July.
    7. Sebastian Calonico & Matias D. Cattaneo & Max H. Farrell & Roc ́ıo Titiunik, 2017. "rdrobust: Software for regression-discontinuity designs," Stata Journal, StataCorp LP, vol. 17(2), pages 372-404, June.
    8. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    9. Levine, David & Polimeni, Rachel & Ramage, Ian, 2016. "Insuring health or insuring wealth? An experimental evaluation of health insurance in rural Cambodia," Journal of Development Economics, Elsevier, vol. 119(C), pages 1-15.
    10. Ambler, Kate & De Brauw,Alan, 2017. "The impacts of cash transfers on women?s empowerment : learning from Pakistan?s BISP program," Policy Research Working Paper Series 113161, The World Bank.
    11. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust Nonparametric Confidence Intervals for Regression‐Discontinuity Designs," Econometrica, Econometric Society, vol. 82, pages 2295-2326, November.
    12. Nawaz, Saima & Iqbal, Nasir, 2021. "How cash transfers program affects environmental poverty among ultra-poor? Insights from the BISP in Pakistan," Energy Policy, Elsevier, vol. 148(PB).
    13. A. Smith, Jeffrey & E. Todd, Petra, 2005. "Does matching overcome LaLonde's critique of nonexperimental estimators?," Journal of Econometrics, Elsevier, vol. 125(1-2), pages 305-353.
    14. Landmann, Andreas & Frölich, Markus, 2015. "Can health-insurance help prevent child labor? An impact evaluation from Pakistan," Journal of Health Economics, Elsevier, vol. 39(C), pages 51-59.
    15. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
    16. Yogi Vidyattama & Riyana Miranti & Budy P. Resosudarmo, 2014. "The Role of Health Insurance Membership in Health Service Utilisation in Indonesia," Bulletin of Indonesian Economic Studies, Taylor & Francis Journals, vol. 50(3), pages 393-413, December.
    17. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 1-37.
    18. Shankar Prinja & Akashdeep Singh Chauhan & Anup Karan & Gunjeet Kaur & Rajesh Kumar, 2017. "Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-19, February.
    19. Imbens,Guido W. & Rubin,Donald B., 2015. "Causal Inference for Statistics, Social, and Biomedical Sciences," Cambridge Books, Cambridge University Press, number 9780521885881.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kämpfen, F.; & Gómez-Olivé, X.; & O’Donnell, O.; & Riumallo Herl, C.;, 2023. "Effectiveness of Population-Based Hypertension Screening: A Multidimensional Regression Discontinuity Design," Health, Econometrics and Data Group (HEDG) Working Papers 23/15, HEDG, c/o Department of Economics, University of York.
    2. Gurgand, Marc & Lorenceau, Adrien & Mélonio, Thomas, 2023. "Student loans: Credit constraints and higher education in South Africa," Journal of Development Economics, Elsevier, vol. 161(C).
    3. Pinotti, Paolo & Bhalotra, Sonia & Britto, Diogo & Sampaio, Breno, 2021. "Job Displacement, Unemployment Benefits and Domestic Violence," CEPR Discussion Papers 16350, C.E.P.R. Discussion Papers.
    4. Casarico, Alessandra & Lattanzio, Salvatore & Profeta, Paola, 2022. "Women and local public finance," European Journal of Political Economy, Elsevier, vol. 72(C).
    5. Pasquini, Ricardo A., 2021. "Effects of regulating the brokerage commission in the rental market: Evidence from Buenos Aires," Journal of Housing Economics, Elsevier, vol. 54(C).
    6. Burgherr, David, 2022. "Behavioral Responses to a Pension Savings Mandate : Quasi-experimental Evidence from Swiss Tax Data," CAGE Online Working Paper Series 645, Competitive Advantage in the Global Economy (CAGE).
    7. Gago Andrés & Carozzi Felipe & Bermejo Vicente J. & Abad Jose M., 2023. "Government Turnover and External Financial Assistance," Asociación Argentina de Economía Política: Working Papers 4655, Asociación Argentina de Economía Política.
    8. Miguel Ángel Carpio & Lucero Gómez & Pablo Lavado, 2021. "Does social health insurance spillover to student performance? Evidence from an RDD in Peru," Working Papers 178, Peruvian Economic Association.
    9. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, vol. 154(C), pages 122-136.
    10. Blaise Melly & Rafael Lalive, 2020. "Estimation, Inference, and Interpretation in the Regression Discontinuity Design," Diskussionsschriften dp2016, Universitaet Bern, Departement Volkswirtschaft.
    11. Daniel Graeber & Felicitas Schikora, 2021. "Hate Is Too Great a Burden to Bear: Hate Crimes and the Mental Health of Refugees," SOEPpapers on Multidisciplinary Panel Data Research 1130, DIW Berlin, The German Socio-Economic Panel (SOEP).
    12. Lisa Bagnoli, 2017. "Does National Health Insurance Improve Children's Health ?National and Regional Evidence from Ghana," Working Papers ECARES ECARES 2017-03, ULB -- Universite Libre de Bruxelles.
    13. Atay, Salim & Asik, Gunes A. & Tumen, Semih, 2023. "Impact of Graduating with Honors on Entry Wages of Economics Majors," IZA Discussion Papers 16080, Institute of Labor Economics (IZA).
    14. Jan Fałkowski & Maciej Jakubowski & Paweł Strawiński, 2014. "Returns from income strategies in rural Poland," The Economics of Transition, The European Bank for Reconstruction and Development, vol. 22(1), pages 139-178, January.
    15. Darius Erlangga & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on healthcare utilisation in Indonesia: evidence from panel data," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(4), pages 603-613, May.
    16. Sanchez-Vidal, Maria, 2019. "Retail shocks and city structure," LSE Research Online Documents on Economics 103394, London School of Economics and Political Science, LSE Library.
    17. Fort, Margherita & Ichino, Andrea & Rettore, Enrico & Zanella, Giulio, 2022. "Multi-cutoff RD designs with observations located at each cutoff: problems and solutions," CEPR Discussion Papers 16974, C.E.P.R. Discussion Papers.
    18. Pastore, Chiara & Jones, Andrew M., 2023. "Human capital consequences of missing out on a grammar school education," Economic Modelling, Elsevier, vol. 126(C).
    19. Krishnan, Pramila & Krutikova, Sofya, 2013. "Non-cognitive skill formation in poor neighbourhoods of urban India," Labour Economics, Elsevier, vol. 24(C), pages 68-85.
    20. Ulf Rinne & Marc Schneider & Arne Uhlendorff, 2011. "Do the skilled and prime-aged unemployed benefit more from training? Effect heterogeneity of public training programmes in Germany," Applied Economics, Taylor & Francis Journals, vol. 43(25), pages 3465-3494.

    More about this item

    Keywords

    Health insurance; Universal health care; Program evaluation; Health care consumption; Pakistan;
    All these keywords.

    JEL classification:

    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • O22 - Economic Development, Innovation, Technological Change, and Growth - - Development Planning and Policy - - - Project Analysis

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pal:genrir:v:47:y:2022:i:1:d:10.1057_s10713-021-00069-0. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.palgrave-journals.com/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.