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Do the more educated utilize more health care services? Evidence from Vietnam using a regression discontinuity design

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  • Thang Dang

    (University of York
    University of Economics Ho Chi Minh City (UEH))

Abstract

In 1991, Vietnam implemented a compulsory primary schooling reform that provides this study a natural experiment to estimate the causal effect of education on health care utilization with a regression discontinuity design. This paper finds that education causes statistically significant impacts on health care utilization, although the signs of the impacts change with specific types of health care services examined. In particular, education increases the inpatient utilization of the public health sector, but it reduces the outpatient utilization of both the public and private health sectors. The estimates are strongly robust to various windows of the sample choice. The paper also discovers that the links between education and the probability of health insurance and income play essential roles as potential mechanisms to explain the causal impact of education on health care utilization in Vietnam.

Suggested Citation

  • Thang Dang, 2018. "Do the more educated utilize more health care services? Evidence from Vietnam using a regression discontinuity design," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 277-299, September.
    • Handle: RePEc:kap:ijhcfe:v:18:y:2018:i:3:d:10.1007_s10754-018-9233-4
    DOI: 10.1007/s10754-018-9233-4
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    1. Thang Dang, 2019. "Quasi-experimental evidence on the political impacts of education in Vietnam," Education Economics, Taylor & Francis Journals, vol. 27(2), pages 207-221, March.
    2. Leuven, Edwin & Plug, Erik & Rønning, Marte, 2016. "Education and cancer risk," Labour Economics, Elsevier, vol. 43(C), pages 106-121.
    3. Altindag, Duha & Cannonier, Colin & Mocan, Naci, 2011. "The impact of education on health knowledge," Economics of Education Review, Elsevier, vol. 30(5), pages 792-812, October.
    4. Matt Dickson & Paul Gregg & Harriet Robinson, 2016. "Early, Late or Never? When Does Parental Education Impact Child Outcomes?," Economic Journal, Royal Economic Society, vol. 126(596), pages 184-231.
    5. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    6. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    7. Matt Dickson & Paul Gregg & Harriet Robinson, 2016. "Early, Late or Never? When Does Parental Education Impact Child Outcomes?," Economic Journal, Royal Economic Society, vol. 126(596), pages 184-231, October.
    8. Webbink, Dinand & Martin, Nicholas G. & Visscher, Peter M., 2010. "Does education reduce the probability of being overweight?," Journal of Health Economics, Elsevier, vol. 29(1), pages 29-38, January.
    9. Gathmann, Christina & Jürges, Hendrik & Reinhold, Steffen, 2015. "Compulsory schooling reforms, education and mortality in twentieth century Europe," Social Science & Medicine, Elsevier, vol. 127(C), pages 74-82.
    10. Erik Hanushek & F. Welch (ed.), 2006. "Handbook of the Economics of Education," Handbook of the Economics of Education, Elsevier, edition 1, volume 1, number 1, June.
    11. Hoai, Nguyen Trong & Dang, Thang, 2016. "The Determinants of self-medication: evidence from urban Vietnam," MPRA Paper 75358, University Library of Munich, Germany.
    12. Grossman, Michael, 2000. "The human capital model," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 7, pages 347-408, Elsevier.
    13. Dang, Thang, 2017. "Education as Protection? The Effect of Schooling on Non-Wage Compensation in a Developing Country," MPRA Paper 79223, University Library of Munich, Germany.
    14. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    15. Tat, Sonny & Barr, Donald, 2006. "Healthcare in the New Vietnam: Comparing patients' satisfaction with outpatient care in a traditional neighborhood clinic and a new, western-style clinic in Ho Chi Minh City," Social Science & Medicine, Elsevier, vol. 62(5), pages 1229-1236, March.
    16. Cuong Viet Nguyen, 2012. "The Impact Of Voluntary Health Insurance On Health Care Utilization And Out‐Of‐Pocket Payments: New Evidence For Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 21(8), pages 946-966, August.
    17. David S. Lee & Thomas Lemieux, 2010. "Regression Discontinuity Designs in Economics," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 281-355, June.
    18. O'Donnell, Owen & van Doorslaer, Eddy & Rannan-Eliya, Ravi P. & Somanathan, Aparnaa & Adhikari, Shiva Raj & Akkazieva, Baktygul & Harbianto, Deni & Garg, Charu C. & Hanvoravongchai, Piya & Herrin, Ale, 2008. "Who pays for health care in Asia?," Journal of Health Economics, Elsevier, vol. 27(2), pages 460-475, March.
    19. Stock, James H & Wright, Jonathan H & Yogo, Motohiro, 2002. "A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments," Journal of Business & Economic Statistics, American Statistical Association, vol. 20(4), pages 518-529, October.
    20. Dang, Thang, 2017. "The Multiple Effects of Child Health Insurance in Vietnam," MPRA Paper 78614, University Library of Munich, Germany.
    21. Imbens, Guido W. & Lemieux, Thomas, 2008. "Regression discontinuity designs: A guide to practice," Journal of Econometrics, Elsevier, vol. 142(2), pages 615-635, February.
    22. Erik Hanushek & F. Welch (ed.), 2006. "Handbook of the Economics of Education," Handbook of the Economics of Education, Elsevier, edition 1, volume 2, number 2, June.
    23. Kruk, Margaret Elizabeth & Freedman, Lynn P., 2008. "Assessing health system performance in developing countries: A review of the literature," Health Policy, Elsevier, vol. 85(3), pages 263-276, March.
    24. Sepehri, Ardeshir & Simpson, Wayne & Sarma, Sisira, 2006. "The influence of health insurance on hospital admission and length of stay--The case of Vietnam," Social Science & Medicine, Elsevier, vol. 63(7), pages 1757-1770, October.
    25. Frijters, Paul & Haisken-DeNew, John P. & Shields, Michael A., 2005. "The causal effect of income on health: Evidence from German reunification," Journal of Health Economics, Elsevier, vol. 24(5), pages 997-1017, September.
    26. Michael Grossman, 1976. "The Correlation between Health and Schooling," NBER Chapters, in: Household Production and Consumption, pages 147-224, National Bureau of Economic Research, Inc.
    27. Frijters, Paul & Haisken-DeNew, John P. & Shields, Michael A., 2005. "The causal effect of income on health: Evidence from German reunification," Journal of Health Economics, Elsevier, vol. 24(5), pages 997-1017, September.
    28. Eide, Eric R. & Showalter, Mark H., 2011. "Estimating the relation between health and education: What do we know and what do we need to know?," Economics of Education Review, Elsevier, vol. 30(5), pages 778-791, October.
    29. Albouy, Valerie & Lequien, Laurent, 2009. "Does compulsory education lower mortality?," Journal of Health Economics, Elsevier, vol. 28(1), pages 155-168, January.
    30. Uplekar, Mukund W., 2000. "Private health care," Social Science & Medicine, Elsevier, vol. 51(6), pages 897-904, September.
    31. Grépin, Karen A. & Bharadwaj, Prashant, 2015. "Maternal education and child mortality in Zimbabwe," Journal of Health Economics, Elsevier, vol. 44(C), pages 97-117.
    32. Cuong Nguyen, 2016. "The impact of health insurance programs for children: evidence from Vietnam," Health Economics Review, Springer, vol. 6(1), pages 1-15, December.
    33. Ian Coxhead & Diep Phan, 2013. "Princelings and Paupers? State Employment and the Distribution of Human Capital Investments Among Households in Viet Nam," Asian Development Review, MIT Press, vol. 30(2), pages 26-48, September.
    34. Ettner, Susan L., 1996. "New evidence on the relationship between income and health," Journal of Health Economics, Elsevier, vol. 15(1), pages 67-85, February.
    35. Grossman, Michael, 2006. "Education and Nonmarket Outcomes," Handbook of the Economics of Education, in: Erik Hanushek & F. Welch (ed.), Handbook of the Economics of Education, edition 1, volume 1, chapter 10, pages 577-633, Elsevier.
    36. 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.
    37. 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.
    38. Palmer, Michael & Mitra, Sophie & Mont, Daniel & Groce, Nora, 2015. "The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach," Social Science & Medicine, Elsevier, vol. 145(C), pages 217-226.
    39. A. J. Culyer & J. P. Newhouse (ed.), 2000. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, edition 1, volume 1, number 1.
    40. Michael Grossman, 2008. "The Relationship Between Health and Schooling," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 34(3), pages 281-292.
    41. Li, Jinhu & Powdthavee, Nattavudh, 2015. "Does more education lead to better health habits? Evidence from the school reforms in Australia," Social Science & Medicine, Elsevier, vol. 127(C), pages 83-91.
    42. Wolffers, Ivan, 1995. "The role of pharmaceuticals in the privatization process in Vietnam's health-care system," Social Science & Medicine, Elsevier, vol. 41(9), pages 1325-1332, November.
    43. Lonnroth, Knut & Thuong, Le Minh & Linh, Pham Duy & Diwan, Vinod, 1998. "Risks and benefits of private health care: exploring physicians' views on private health care in Ho Chi Minh City, Vietnam," Health Policy, Elsevier, vol. 45(2), pages 81-97, August.
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    Cited by:

    1. Richard Agbanyo & James Atta Peprah, 2021. "National health insurance and the choice of delivery facility among expectant mothers in Ghana," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 27-49, March.
    2. Dai Binh Tran, 2022. "Health Benefits of Education: Comparative Evidence from Vietnam and Thailand," SAGE Open, , vol. 12(2), pages 21582440221, April.
    3. Mauricio Villamizar‐Villegas & Freddy A. Pinzon‐Puerto & Maria Alejandra Ruiz‐Sanchez, 2022. "A comprehensive history of regression discontinuity designs: An empirical survey of the last 60 years," Journal of Economic Surveys, Wiley Blackwell, vol. 36(4), pages 1130-1178, September.
    4. Dang, Thang, 2017. "Education as Protection? The Effect of Schooling on Non-Wage Compensation in a Developing Country," MPRA Paper 79223, University Library of Munich, Germany.
    5. Dang, Thang, 2017. "The Multiple Effects of Child Health Insurance in Vietnam," MPRA Paper 78614, University Library of Munich, Germany.
    6. Thang Dang, 2022. "Retirement and health services utilization in a low‐income country," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 30(3), pages 597-620, July.

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    More about this item

    Keywords

    Education; Health care utilization; Regression discontinuity design; Vietnam;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I21 - Health, Education, and Welfare - - Education - - - Analysis of Education
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth

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