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Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting

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  • Steven F. Koch

    ()
    (Department of Economics, University of Pretoria)

  • Jeffrey S. Racine

    ()
    (Department of Economics & Graduate Program in Statistics, Department of Mathematics, McMaster University, Hamilton, Ontario, Canada L8S 4M4)

Abstract

We apply parametric and nonparametric regression discontinuity methodology within a multinomial choice setting to examine the impact of public health care user fee abolition on health facility choice using data from South Africa. The nonparametric model is found to outperform the parametric model both in- and out-of-sample, while also delivering more plausible estimates of the impact of user fee abolition (i.e. the `treatment effect'). In the parametric framework, treatment effects were relatively constant – around 7% – and that increase was drawn equally from both home care and private care groups. On the other hand, in the nonparametric framework treatment effects were largest for the least well-off (also around 7%) but fell for the most well-off. More plausibly, that increase was drawn primarily from the home care group, suggesting that the policy favoured those least well-off as more of these children received at least some minimum level of professional health care after the policy was implemented. Regarding the most well-off, despite having access to free public health care, children were still far more likely to receive health care at private facilities than at public facilities, which is also more plausible in South Africa’s two-tier health sector.

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Bibliographic Info

Paper provided by University of Pretoria, Department of Economics in its series Working Papers with number 201353.

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Length: 36 pages
Date of creation: Sep 2013
Date of revision:
Handle: RePEc:pre:wpaper:201353

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  1. Tristen Hayfield & Jeffrey S. Racine, . "Nonparametric Econometrics: The np Package," Journal of Statistical Software, American Statistical Association, vol. 27(i05).
  2. Guido Imbens & Karthik Kalyanaraman, 2009. "Optimal Bandwidth Choice for the Regression Discontinuity Estimator," NBER Working Papers 14726, National Bureau of Economic Research, Inc.
  3. David S. Lee & Thomas Lemieux, 2009. "Regression Discontinuity Designs In Economics," Working Papers 1118, Princeton University, Department of Economics, Industrial Relations Section..
  4. Li, Qi & Racine, Jeff, 2003. "Nonparametric estimation of distributions with categorical and continuous data," Journal of Multivariate Analysis, Elsevier, vol. 86(2), pages 266-292, August.
  5. Guido Imbens & Thomas Lemieux, 2007. "Regression Discontinuity Designs: A Guide to Practice," NBER Working Papers 13039, National Bureau of Economic Research, Inc.
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  7. Johannes F. Schmieder & Till von Wachter & Stefan Bender, 2012. "The Effects of Extended Unemployment Insurance Over the Business Cycle: Evidence from Regression Discontinuity Estimates Over 20 Years," The Quarterly Journal of Economics, Oxford University Press, vol. 127(2), pages 701-752.
  8. Jeffrey S. Racine & Christopher F. Parmeter, 2012. "Data-Driven Model Evaluation: A Test for Revealed Performance," Department of Economics Working Papers 2012-13, McMaster University.
  9. Racine, Jeffrey S., 2008. "Nonparametric Econometrics: A Primer," Foundations and Trends(R) in Econometrics, now publishers, vol. 3(1), pages 1-88, March.
  10. Milligan, Kevin & Lemieux, Thomas, 2006. "Incentive Effects of Social Assistance: A Regression Discontinuity Approach," Analytical Studies Branch Research Paper Series 2006280e, Statistics Canada, Analytical Studies Branch.
  11. Ou, Dongshu, 2010. "To leave or not to leave? A regression discontinuity analysis of the impact of failing the high school exit exam," Economics of Education Review, Elsevier, vol. 29(2), pages 171-186, April.
  12. Coe, Norma B. & Zamarro, Gema, 2011. "Retirement effects on health in Europe," Journal of Health Economics, Elsevier, vol. 30(1), pages 77-86, January.
  13. Lindeboom, Maarten & Llena-Nozal, Ana & van der Klaauw, Bas, 2006. "Parental Education and Child Health: Evidence from a Schooling Reform," IZA Discussion Papers 2516, Institute for the Study of Labor (IZA).
  14. Christopher Carpenter & Carlos Dobkin, 2009. "The Effect of Alcohol Consumption on Mortality: Regression Discontinuity Evidence from the Minimum Drinking Age," American Economic Journal: Applied Economics, American Economic Association, vol. 1(1), pages 164-82, January.
  15. William R. Kerr & Josh Lerner & Antoinette Schoar, 2010. "The Consequences of Entrepreneurial Finance: A Regression Discontinuity Analysis," NBER Working Papers 15831, National Bureau of Economic Research, Inc.
  16. Gupta, Indrani & Dasgupta, Puranmita, 2002. "Demand for Curative Health Care in Rural India: Choosing between Private, Public and No Care," Working Papers 82, National Council of Applied Economic Research.
  17. Steven F. Koch, 2012. "The Abolition Of User Fees And The Demand For Health Care: Re-Evaluating The Impact," Working Papers 201219, University of Pretoria, Department of Economics.
  18. Justin McCrary & Heather Royer, 2006. "The Effect of Female Education on Fertility and Infant Health: Evidence from School Entry Policies Using Exact Date of Birth," NBER Working Papers 12329, National Bureau of Economic Research, Inc.
  19. Koch, Steven & Alaba, Olufunke, 2010. "On health insurance and household decisions: A treatment effect analysis," Social Science & Medicine, Elsevier, vol. 70(2), pages 175-182, January.
  20. David Card & Carlos Dobkin & Nicole Maestas, 2004. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization and Health: Evidence from Medicare," NBER Working Papers 10365, National Bureau of Economic Research, Inc.
  21. Peter Hall & Jeff Racine & Qi Li, 2004. "Cross-Validation and the Estimation of Conditional Probability Densities," Journal of the American Statistical Association, American Statistical Association, vol. 99, pages 1015-1026, December.
  22. Jean‐Louis Arcand & Eric Djimeu Wouabe, 2010. "Teacher training and HIV/AIDS prevention in West Africa: regression discontinuity design evidence from the Cameroon," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 36-54, September.
  23. Qi Li & Jeffrey S. Racine & Jeffrey M. Wooldridge, 2008. "Estimating Average Treatment Effects with Continuous and Discrete Covariates: The Case of Swan-Ganz Catheterization," American Economic Review, American Economic Association, vol. 98(2), pages 357-62, May.
  24. Albouy, Valerie & Lequien, Laurent, 2009. "Does compulsory education lower mortality?," Journal of Health Economics, Elsevier, vol. 28(1), pages 155-168, January.
  25. Silles, Mary A., 2009. "The causal effect of education on health: Evidence from the United Kingdom," Economics of Education Review, Elsevier, vol. 28(1), pages 122-128, February.
  26. John DiNardo & David S. Lee, 2002. "The Impact of Unionization on Establishment Closure: A Regression Discontinuity Analysis of Representation Elections," NBER Working Papers 8993, National Bureau of Economic Research, Inc.
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