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Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance

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Author Info

  • Winnie Yip

    (Harvard School of Public Health, Program in Health Care Financing, University Place, Cambridge, MA, USA)

  • Peter Berman

    (Harvard School of Public Health, Program in Health Care Financing, University Place, Cambridge, MA, USA)

Abstract

Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Our findings show that the SHIP significantly improved access by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). With regard to the success of targeting the poor, conditional upon being covered, the SHIP reduced the differentials in visit rates between the highest and lowest income children. However, only the middle-income children benefitted from reduced financial burden (within group equity). Moreover, by targeting the children through school enrollment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Children not attending school tend to be poor and living in rural areas. Our results also indicate that original calculations may underestimate the SHIP financial outlays, thereby threatening the long run financial sustainability of the programme. Copyright © 2001 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.589
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 10 (2001)
Issue (Month): 3 ()
Pages: 207-220

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Handle: RePEc:wly:hlthec:v:10:y:2001:i:3:p:207-220

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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  1. Mbugua, J. Karanja & Bloom, Gerald H. & Segall, Malcolm M., 1995. "Impact of user charges on vulnerable groups: The case of Kibwezi in rural Kenya," Social Science & Medicine, Elsevier, vol. 41(6), pages 829-835, September.
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  3. Castro-Leal, Florencia & Dayton, Julia & Demery, Lionel & Mehra, Kalpana, 1999. "Public Social Spending in Africa: Do the Poor Benefit?," World Bank Research Observer, World Bank Group, vol. 14(1), pages 49-72, February.
  4. Cebu Study Team, 1992. "A child health production function estimated from longitudinal data," Journal of Development Economics, Elsevier, vol. 38(2), pages 323-351, April.
  5. Nandakumar, A. K. & Reich, Michael R. & Chawla, Mukesh & Berman, Peter & Yip, Winnie, 2000. "Health reform for children: the Egyptian experience with school health insurance," Health Policy, Elsevier, vol. 50(3), pages 155-170, January.
  6. Robert Kaestner & Theodore Joyce & Andrew Racine, 1999. "Does Publicly Provided Health Insurance Improve the Health of Low-Income Children in the United States," NBER Working Papers 6887, National Bureau of Economic Research, Inc.
  7. Manning, W. G. & Duan, N. & Rogers, W. H., 1987. "Monte Carlo evidence on the choice between sample selection and two-part models," Journal of Econometrics, Elsevier, vol. 35(1), pages 59-82, May.
  8. Leemore Dafny & Jonathan Gruber, 2000. "Does Public Insurance Improve the Efficiency of Medical Care? Medicaid Expansions and Child Hospitalizations," NBER Working Papers 7555, National Bureau of Economic Research, Inc.
  9. Rosenzweig, Mark R & Wolpin, Kenneth I, 1986. "Evaluating the Effects of Optimally Distributed Public Programs: ChildHealth and Family Planning Interventions," American Economic Review, American Economic Association, vol. 76(3), pages 470-82, June.
  10. Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987. "Are user fees regressive? : The welfare implications of health care financing proposals in Peru," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 67-88.
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Cited by:
  1. Nguyen Viet, Cuong, 2011. "The Impact of Health Insurance for Children: Evidence from Vietnam," MPRA Paper 36552, University Library of Munich, Germany.
  2. Menno Pradhan & Fadia Saadah & Robert Sparrow, 2003. "Did the Healthcard Program ensure Access to Medical Care for the Poor during Indonesia's Economic Crisis?," Tinbergen Institute Discussion Papers 03-016/2, Tinbergen Institute.
  3. Hidayat, Budi, 2007. "Are there differences between unconditional and conditional demand estimates? implications for future research and policy," MPRA Paper 30196, University Library of Munich, Germany.
  4. Matthew Jowett, 2004. "Theoretical insights into the development of health insurance in low-income countries," Working Papers 188chedp, Centre for Health Economics, University of York.
  5. Pia Schneider & Kara Hanson, 2006. "Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 19-31.
  6. Somanathan, Aparnaa, 2008. "The impact of price subsidies on child health care use : evaluation of the Indonesian healthcard," Policy Research Working Paper Series 4622, The World Bank.
  7. Mohammad Hajizadeh & Luke B. Connelly & James R.G. Butler & Aredshir Khosravi, 2012. "Unmet need and met unneed in health care utilisation in Iran," International Journal of Social Economics, Emerald Group Publishing, vol. 39(6), pages 400-422, May.
  8. Fernando Ruiz & Liliana Amaya & Stella Venegas, 2007. "Progressive segmented health insurance: Colombian health reform and access to health services," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 3-18.
  9. Chaudhuri, Anoshua & Roy, Kakoli, 2008. "Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002," Health Policy, Elsevier, vol. 88(1), pages 38-48, October.
  10. Jutting, Johannes P., 2004. "Do Community-based Health Insurance Schemes Improve Poor People's Access to Health Care? Evidence From Rural Senegal," World Development, Elsevier, vol. 32(2), pages 273-288, February.
  11. 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.
  12. Yilma, Zelalem & van Kempen, Luuk & de Hoop, Thomas, 2012. "A perverse ‘net’ effect? Health insurance and ex-ante moral hazard in Ghana," Social Science & Medicine, Elsevier, vol. 75(1), pages 138-147.
  13. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a low-income country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857.

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