IDEAS home Printed from https://ideas.repec.org/a/eee/pubeco/v121y2015icp79-94.html
   My bibliography  Save this article

Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand

Author

Listed:
  • Limwattananon, Supon
  • Neelsen, Sven
  • O'Donnell, Owen
  • Prakongsai, Phusit
  • Tangcharoensathien, Viroj
  • van Doorslaer, Eddy
  • Vongmongkol, Vuthiphan

Abstract

We estimate the impact on out-of-pocket (OOP) medical expenditure of a major reform in Thailand that greatly extended health insurance coverage to achieve universality while implementing supply-side measures intended to deliver cost-effective care from an increased, but modest, public health budget. Difference-in-differences comparison of groups to whom coverage was extended or deepened with those whose coverage did not change indicates that the reform reduced OOP expenditure by 28% on average and by 42% at the 95th percentile of the conditional distribution. Simulations suggest that exposure to medical expenditure risk was reduced by three-fifths, on average, generating a social welfare gain equivalent to 80–200% of the approximate deadweight loss from financing the reform. Estimated effects on health care access suggest that the policy managed to reduce households' medical expenses while also raising their utilization of both inpatient and ambulatory care.

Suggested Citation

  • Limwattananon, Supon & Neelsen, Sven & O'Donnell, Owen & Prakongsai, Phusit & Tangcharoensathien, Viroj & van Doorslaer, Eddy & Vongmongkol, Vuthiphan, 2015. "Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand," Journal of Public Economics, Elsevier, vol. 121(C), pages 79-94.
  • Handle: RePEc:eee:pubeco:v:121:y:2015:i:c:p:79-94
    DOI: 10.1016/j.jpubeco.2014.11.012
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S004727271400245X
    Download Restriction: Full text for ScienceDirect subscribers only

    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. Gourieroux, Christian & Monfort, Alain & Trognon, Alain, 1984. "Pseudo Maximum Likelihood Methods: Theory," Econometrica, Econometric Society, vol. 52(3), pages 681-700, May.
    2. Auriol, Emmanuelle & Warlters, Michael, 2012. "The marginal cost of public funds and tax reform in Africa," Journal of Development Economics, Elsevier, vol. 97(1), pages 58-72.
    3. Chetty, Raj & Looney, Adam, 2006. "Consumption smoothing and the welfare consequences of social insurance in developing economies," Journal of Public Economics, Elsevier, vol. 90(12), pages 2351-2356, December.
    4. Stefan Dercon & Pramila Krishnan, 2000. "In Sickness and in Health: Risk Sharing within Households in Rural Ethiopia," Journal of Political Economy, University of Chicago Press, vol. 108(4), pages 688-727, August.
    5. Gourieroux, Christian & Monfort, Alain & Trognon, Alain, 1984. "Pseudo Maximum Likelihood Methods: Applications to Poisson Models," Econometrica, Econometric Society, vol. 52(3), pages 701-720, May.
    6. repec:eee:pubeco:v:154:y:2017:i:c:p:122-136 is not listed on IDEAS
    7. 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.
    8. Koenker, Roger W & Bassett, Gilbert, Jr, 1978. "Regression Quantiles," Econometrica, Econometric Society, vol. 46(1), pages 33-50, January.
    9. Manning, Willard G., 1998. "The logged dependent variable, heteroscedasticity, and the retransformation problem," Journal of Health Economics, Elsevier, vol. 17(3), pages 283-295, June.
    10. Robert M. Townsend, 1995. "Consumption Insurance: An Evaluation of Risk-Bearing Systems in Low-Income Economies," Journal of Economic Perspectives, American Economic Association, vol. 9(3), pages 83-102, Summer.
    11. 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.
    12. Gary V. Engelhardt & Jonathan Gruber, 2011. "Medicare Part D and the Financial Protection of the Elderly," American Economic Journal: Economic Policy, American Economic Association, vol. 3(4), pages 77-102, November.
    13. Hughes, David & Leethongdee, Songkramchai & Osiri, Sunantha, 2010. "Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms," Social Science & Medicine, Elsevier, vol. 70(3), pages 447-454, February.
    14. Supon Limwattananon & Sven Neelsen & Owen O'Donnell & Phusit Prakongsai & Viroj Tangcharoensathien & Eddy van Doorslaer & Vuthiphan Vongmongkol, 2013. "Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand," CESifo Working Paper Series 4262, CESifo Group Munich.
    15. Jonathan Gruber & Nathaniel Hendren & Robert M. Townsend, 2014. "The Great Equalizer: Health Care Access and Infant Mortality in Thailand," American Economic Journal: Applied Economics, American Economic Association, vol. 6(1), pages 91-107, January.
    16. Martin Feldstein & Jonathan Gruber, 1995. "A Major Risk Approach to Health Insurance Reform," NBER Chapters,in: Tax Policy and the Economy, Volume 9, pages 103-130 National Bureau of Economic Research, Inc.
    17. Manoj Mohanan, 2013. "Causal Effects of Health Shocks on Consumption and Debt: Quasi-Experimental Evidence from Bus Accident Injuries," The Review of Economics and Statistics, MIT Press, vol. 95(2), pages 673-681, May.
    18. Panpiemras, Jirawat & Puttitanun, Thitima & Samphantharak, Krislert & Thampanishvong, Kannika, 2011. "Impact of Universal Health Care Coverage on patient demand for health care services in Thailand," Health Policy, Elsevier, vol. 103(2), pages 228-235.
    19. Santos Silva, J.M.C. & Tenreyro, Silvana, 2011. "Further simulation evidence on the performance of the Poisson pseudo-maximum likelihood estimator," Economics Letters, Elsevier, vol. 112(2), pages 220-222, August.
    20. Asfaw, Abay & von Braun, Joachim, 2004. "Is Consumption Insured against Illness? Evidence on Vulnerability of Households to Health Shocks in Rural Ethiopia," Economic Development and Cultural Change, University of Chicago Press, vol. 53(1), pages 115-129, October.
    21. Adam Wagstaff & Mariam Claeson, 2004. "The Millennium Development Goals for Health : Rising to the Challenges," World Bank Publications, The World Bank, number 14954.
    22. Puhani, Patrick A., 2012. "The treatment effect, the cross difference, and the interaction term in nonlinear “difference-in-differences” models," Economics Letters, Elsevier, vol. 115(1), pages 85-87.
    23. Somkotra, Tewarit & Lagrada, Leizel P., 2008. "Payments for health care and its effect on catastrophe and impoverishment: Experience from the transition to Universal Coverage in Thailand," Social Science & Medicine, Elsevier, vol. 67(12), pages 2027-2035, December.
    24. J. M. C. Santos Silva & Silvana Tenreyro, 2006. "The Log of Gravity," The Review of Economics and Statistics, MIT Press, vol. 88(4), pages 641-658, November.
    25. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    26. Kondo, Ayako & Shigeoka, Hitoshi, 2013. "Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan," Journal of Public Economics, Elsevier, vol. 99(C), pages 1-23.
    27. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, January.
    28. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    29. Susan Athey & Guido W. Imbens, 2006. "Identification and Inference in Nonlinear Difference-in-Differences Models," Econometrica, Econometric Society, vol. 74(2), pages 431-497, March.
    30. Grant Miller & Diana Pinto & Marcos Vera-Hernández, 2013. "Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor," American Economic Journal: Applied Economics, American Economic Association, vol. 5(4), pages 61-91, October.
    31. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, Oxford University Press, vol. 127(3), pages 1057-1106.
    32. Donald Meyer & Jack Meyer, 2005. "Relative Risk Aversion: What Do We Know?," Journal of Risk and Uncertainty, Springer, vol. 31(3), pages 243-262, December.
    33. Islam, Asadul & Maitra, Pushkar, 2012. "Health shocks and consumption smoothing in rural households: Does microcredit have a role to play?," Journal of Development Economics, Elsevier, vol. 97(2), pages 232-243.
    34. Maria Eugenia Genoni, 2012. "Health Shocks and Consumption Smoothing: Evidence from Indonesia," Economic Development and Cultural Change, University of Chicago Press, vol. 60(3), pages 475-506.
    35. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933.
    36. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    37. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    38. James M. Poterba, 1996. "Government Intervention in the Markets for Education and Health Care: How and Why?," NBER Chapters,in: Individual and Social Responsibility: Child Care, Education, Medical Care, and Long-Term Care in America, pages 277-308 National Bureau of Economic Research, Inc.
    39. Christopher J. Bennett, 2013. "Inference For Dominance Relations," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 54, pages 1309-1328, November.
    40. Bev Dahlby, 2008. "The Marginal Cost of Public Funds: Theory and Applications," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262042509, January.
    41. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
    42. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 1-37.
    43. Hong H. & Chernozhukov V., 2002. "Three-Step Censored Quantile Regression and Extramarital Affairs," Journal of the American Statistical Association, American Statistical Association, vol. 97, pages 872-882, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. repec:eee:jhecon:v:55:y:2017:i:c:p:14-29 is not listed on IDEAS
    2. repec:eee:pubeco:v:150:y:2017:i:c:p:75-93 is not listed on IDEAS
    3. Flores, Gabriela & O’Donnell, Owen, 2016. "Catastrophic medical expenditure risk," Journal of Health Economics, Elsevier, vol. 46(C), pages 1-15.
    4. Rieger, Matthias & Wagner, Natascha & Bedi, Arjun S., 2017. "Universal health coverage at the macro level: Synthetic control evidence from Thailand," Social Science & Medicine, Elsevier, vol. 172(C), pages 46-55.
    5. Cesur, Resul & Güneş, Pınar Mine & Tekin, Erdal & Ulker, Aydogan, 2017. "The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey," Journal of Public Economics, Elsevier, vol. 150(C), pages 75-93.
    6. Rieger, M. & Wagner, N. & Bedi, A.S., 2015. "Macroeconomic impacts of Universal Health Coverage : Synthetic control evidence from Thailand," ISS Working Papers - General Series 609, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    7. Gabriella Conti & Rita Ginja, 2017. "Who benefits from free health insurance: evidence from Mexico," IFS Working Papers W17/26, Institute for Fiscal Studies.
    8. repec:eee:pubeco:v:154:y:2017:i:c:p:122-136 is not listed on IDEAS
    9. Adam Wagstaff & Daniel Cotlear & Patrick Hoang-Vu Eozenou & Leander R. Buisman, 2016. "Measuring progress towards universal health coverage: with an application to 24 developing countries," Oxford Review of Economic Policy, Oxford University Press, vol. 32(1), pages 147-189.
    10. Natt Hongdilokkul, 2017. "Welfare Analysis of the Universal Health Care Program in Thailand," PIER Discussion Papers 58, Puey Ungphakorn Institute for Economic Research, revised May 2017.
    11. 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.
    12. 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.
    13. Sven Neelsen & Supon Limwattananon & Owen O'Donnell & Eddy van Doorslaer, 2015. "Economic Impact of Illness with Health Insurance but without Income Insurance," Tinbergen Institute Discussion Papers 15-060/V, Tinbergen Institute.
    14. Shigute, Zemzem & Strupat, Christoph & Burchi, Francesco & Alemu, Getnet & Bedi, Arjun S., 2017. "The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia," IZA Discussion Papers 10939, Institute for the Study of Labor (IZA).
    15. Sven Neelsen & Owen O’Donnell, 2016. "Progressive Universalism? The Impact of Targeted Coverage on Healthcare Access and Expenditures in Peru," Tinbergen Institute Discussion Papers 16-019/V, Tinbergen Institute.
    16. 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.

    More about this item

    Keywords

    Health insurance; Medical expenditure; Universal coverage; Health care; Thailand;

    JEL classification:

    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    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:eee:pubeco:v:121:y:2015:i:c:p:79-94. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: http://www.elsevier.com/locate/inca/505578 .

    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 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.