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Heterogeneous effect of health insurance on financial risk: Evidence from two successive surveys in Ghana

Author

Listed:
  • Samuel Ampaw
  • Simon Appleton
  • Xuyan Lou

Abstract

This paper evaluates the heterogeneous effect of health insurance on out-of-pocket healthcare expenditure (OOPHE), using merged data from the Ghana Living Standards Survey and Ghana Health Service reports. It applies conditional-mixed process and censored quantile instrumental variable estimators to tackle censoring and endogeneity. We instrument household insurance rate with community insurance rate (exclusive of the observed household) and control for community unobservables. The quantile regression allows the insurance effect to differ across the distribution of OOPHE. We further perform separate analyses by the types of OOPHE and selected covariates. The results show that insurance reduced OOPHE and the incidence of catastrophic OOPHE in 2013, but not in 2017. Besides, households in the higher expenditure quantiles benefitted more from coverage than those in the median and lower quantiles did in 2013. Also, the insurance benefits accrued exclusively to the wealthiest households, households with older heads, and users of outpatient services in 2013. Lastly, the 2013 survey reveals that families with female heads and those whose heads had primary education benefitted more from health insurance than their counterparts in the other subgroups did. The paper concludes that same health insurance can have varied financial risk implications at different periods, across the distribution of OOPHE, and among various household categories.

Suggested Citation

  • Samuel Ampaw & Simon Appleton & Xuyan Lou, 2020. "Heterogeneous effect of health insurance on financial risk: Evidence from two successive surveys in Ghana," Discussion Papers 2020-04, University of Nottingham, CREDIT.
    • Handle: RePEc:not:notcre:20/04
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    References listed on IDEAS

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    1. Dixon, Jenna & Luginaah, Isaac & Mkandawire, Paul, 2014. "The National Health Insurance Scheme in Ghana's Upper West Region: A gendered perspective of insurance acquisition in a resource-poor setting," Social Science & Medicine, Elsevier, vol. 122(C), pages 103-112.
    2. Barnes, Kayleigh & Mukherji, Arnab & Mullen, Patrick & Sood, Neeraj, 2017. "Financial risk protection from social health insurance," Journal of Health Economics, Elsevier, vol. 55(C), pages 14-29.
    3. Li, Xin & Zhang, Wei, 2013. "The impacts of health insurance on health care utilization among the older people in China," Social Science & Medicine, Elsevier, vol. 85(C), pages 59-65.
    4. Azam, Mehtabul, 2018. "Does Social Health Insurance Reduce Financial Burden? Panel Data Evidence from India," World Development, Elsevier, vol. 102(C), pages 1-17.
    5. Craig L. Garthwaite, 2012. "The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions," American Economic Journal: Economic Policy, American Economic Association, vol. 4(3), pages 190-215, August.
    6. Bucheli, José R. & Fontenla, Matías & Waddell, Benjamin James, 2019. "Return migration and violence," World Development, Elsevier, vol. 116(C), pages 113-124.
    7. Zhang, Anwen & Nikoloski, Zlatko & Mossialos, Elias, 2017. "Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly," Social Science & Medicine, Elsevier, vol. 190(C), pages 11-19.
    8. Liu, Hong & Zhao, Zhong, 2014. "Does health insurance matter? Evidence from China’s urban resident basic medical insurance," Journal of Comparative Economics, Elsevier, vol. 42(4), pages 1007-1020.
    9. Stephen Abrokwah & Christine Moser & Edward Norton, 2014. "The effect of social health insurance on prenatal care: the case of Ghana," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 385-406, December.
    10. Hayne E. Leland, 1968. "Saving and Uncertainty: The Precautionary Demand for Saving," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 82(3), pages 465-473.
    11. Dreze, Jacques H. & Modigliani, Franco, 1972. "Consumption decisions under uncertainty," Journal of Economic Theory, Elsevier, vol. 5(3), pages 308-335, December.
    12. AfDB AfDB, . "Annual Report 2012," Annual Report, African Development Bank, number 461.
    13. Council on Food Agricultural and Resource Economics, C-FARE, 2014. "2013 Annual Report," C-FARE Reports 260836, Council on Food, Agricultural, and Resource Economics (C-FARE).
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    Keywords

    health insurance; financial risk protection; out-of-pocket healthcare expenditure; catastrophic healthcare expenditure; quantile regression; Ghana;
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