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On health insurance and household decisions: A treatment effect analysis

  • Koch, Steven
  • Alaba, Olufunke

In developing countries, where health insurance is not a commonly purchased financial instrument, recent debates have revolved around extending health insurance coverage to a wider range of the population, primarily via compulsory insurance schemes. However, these debates rarely consider the competing demands placed on the family budget, which will influence the acceptability of the program by the populace. In this paper, we draw on data from the 2000 income and expenditure survey to examine treatment effects associated with household insurance status, providing a detailed examination of expenditure substitution patterns within South Africa. In agreement with economic theory, the expansion of health insurance coverage via compulsory schemes creates additional burdens for households, which households accommodate via expenditure substitution. The observed variation in the household's ability to accommodate increased expenditure can and should be used in future to assess policy options and in the design of an optimal social health insurance program.

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Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 70 (2010)
Issue (Month): 2 (January)
Pages: 175-182

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Handle: RePEc:eee:socmed:v:70:y:2010:i:2:p:175-182
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  1. Chou, Shin-Yi & Liu, Jin-Tan & Hammitt, James K., 2003. "National Health Insurance and precautionary saving: evidence from Taiwan," Journal of Public Economics, Elsevier, vol. 87(9-10), pages 1873-1894, September.
  2. Marc Ground & Steven f Koch, 2008. "Hurdle Models Of Alcohol And Tobacco Expenditure In South African Households," South African Journal of Economics, Economic Society of South Africa, vol. 76(1), pages 132-143, 03.
  3. Christelle Swanepoel & Ian Stuart, 2006. "Health Care Provider Choice," Working Papers 11/2006, Stellenbosch University, Department of Economics.
  4. James J. Heckman & Edward Vytlacil, 2005. "Structural Equations, Treatment Effects, and Econometric Policy Evaluation," Econometrica, Econometric Society, vol. 73(3), pages 669-738, 05.
  5. Guido Imbens & Jeffrey Wooldridge, 2008. "Recent developments in the econometrics of program evaluation," CeMMAP working papers CWP24/08, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.
  6. Bloom, Gerald & McIntyre, Diane, 1998. "Towards equity in health in an unequal society," Social Science & Medicine, Elsevier, vol. 47(10), pages 1529-1538, November.
  7. Reza Daniels, 2008. "The income distribution with coarse data," Working Papers 82, Economic Research Southern Africa.
  8. Steven F. Koch & Gauthier Tshiswaka-Kashalala, 2008. "Tobacco Substitution and the Poor," Working Papers 200832, University of Pretoria, Department of Economics.
  9. Bundorf, M. Kate & Pauly, Mark V., 2006. "Is health insurance affordable for the uninsured?," Journal of Health Economics, Elsevier, vol. 25(4), pages 650-673, July.
  10. J. Scott Shonkwiler & Steven T. Yen, 1999. "Two-Step Estimation of a Censored System of Equations," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 81(4), pages 972-982.
  11. John, Rijo M., 2008. "Crowding out effect of tobacco expenditure and its implications on household resource allocation in India," Social Science & Medicine, Elsevier, vol. 66(6), pages 1356-1367, March.
  12. Frederic Vermeulen, 2003. "Do smokers behave differently? A tale of zero expenditures and separability concepts," Economics Bulletin, AccessEcon, vol. 4(6), pages 1-7.
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