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Health shock and indebtedness: Does having access to health insurance reduce the reliance on borrowing as a shock coping strategy?

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  • Linh D. Nguyen
  • Thanh T. Nguyen
  • Tung T. Nguyen
  • Ulrike Grote

Abstract

Households in developing countries are often impaired in their economic opportunities by major health shocks. In this article, we first investigate the impact of a health shock on rural household consumption and explore the mechanisms how the health shock brings a household into indebtedness. We then examine the role of health insurance in reducing the reliance on borrowing as a shock coping strategy. Our estimations show that while rural households are able to insure non‐health‐related consumption, a health shock pushes them into severe indebtedness by increasing informal borrowing to smooth consumption. Promotion of health insurance is recommended as it helps to protect households from falling into severe indebtedness when a health shock strikes.

Suggested Citation

  • Linh D. Nguyen & Thanh T. Nguyen & Tung T. Nguyen & Ulrike Grote, 2025. "Health shock and indebtedness: Does having access to health insurance reduce the reliance on borrowing as a shock coping strategy?," Applied Economic Perspectives and Policy, John Wiley & Sons, vol. 47(2), pages 823-862, May.
  • Handle: RePEc:wly:apecpp:v:47:y:2025:i:2:p:823-862
    DOI: 10.1002/aepp.13495
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    1. Townsend, Robert M, 1994. "Risk and Insurance in Village India," Econometrica, Econometric Society, vol. 62(3), pages 539-591, May.
    2. Robert Sparrow & Ellen Van de Poel & Gracia Hadiwidjaja & Athia Yumna & Nila Warda & Asep Suryahadi, 2014. "Coping With The Economic Consequences Of Ill Health In Indonesia," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 719-728, June.
    3. Dalton, Michael & LaFave, Daniel, 2017. "Mitigating the consequences of a health condition: The role of intra- and interhousehold assistance," Journal of Health Economics, Elsevier, vol. 53(C), pages 38-52.
    4. 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.
    5. Lewbel, Arthur, 2018. "Identification and estimation using heteroscedasticity without instruments: The binary endogenous regressor case," Economics Letters, Elsevier, vol. 165(C), pages 10-12.
    6. Stephen B. DeLoach & Marquessa Smith-Lin, 2018. "The Role of Savings and Credit in Coping with Idiosyncratic Household Shocks," Journal of Development Studies, Taylor & Francis Journals, vol. 54(9), pages 1513-1533, September.
    7. repec:eee:labchp:v:3:y:1999:i:pc:p:3309-3416 is not listed on IDEAS
    8. Mace, Barbara J, 1991. "Full Insurance in the Presence of Aggregate Uncertainty," Journal of Political Economy, University of Chicago Press, vol. 99(5), pages 928-956, October.
    9. Paul Gertler & David I. Levine & Enrico Moretti, 2009. "Do microfinance programs help families insure consumption against illness?," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 257-273, March.
    10. Liu, Kai, 2016. "Insuring against health shocks: Health insurance and household choices," Journal of Health Economics, Elsevier, vol. 46(C), pages 16-32.
    11. repec:plo:pone00:0225237 is not listed on IDEAS
    12. 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.
    13. Rebecca Hartje & Michael Hübler, 2017. "Smartphones support smart labour," Applied Economics Letters, Taylor & Francis Journals, vol. 24(7), pages 467-471, April.
    14. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    15. Daniel L. Millimet & Ian K. McDonough, 2017. "Dynamic Panel Data Models With Irregular Spacing: With an Application to Early Childhood Development," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 32(4), pages 725-743, June.
    16. Arnab Acharya & Sukumar Vellakkal & Fiona Taylor & Edoardo Masset & Ambika Satija & Margaret Burke & Shah Ebrahim, 2013. "The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review," The World Bank Research Observer, World Bank, vol. 28(2), pages 236-266, August.
    17. Trung Thanh Nguyen & Viet Tuan Tran & Thanh-Tung Nguyen & Ulrike Grote, 2021. "Farming efficiency, cropland rental market and income effect: evidence from panel data for rural Central Vietnam," European Review of Agricultural Economics, Oxford University Press and the European Agricultural and Applied Economics Publications Foundation, vol. 48(1), pages 207-248.
    18. Arellano, Manuel & Bover, Olympia, 1995. "Another look at the instrumental variable estimation of error-components models," Journal of Econometrics, Elsevier, vol. 68(1), pages 29-51, July.
    19. Timothy Powell‐Jackson & Mohammad Enamul Hoque, 2012. "Economic Consequences Of Maternal Illness In Rural Bangladesh," Health Economics, John Wiley & Sons, Ltd., vol. 21(7), pages 796-810, July.
    20. Truong Lam Do & Trung Thanh Nguyen & Ulrike Grote, 2019. "Livestock Production, Rural Poverty, and Perceived Shocks: Evidence from Panel Data for Vietnam," Journal of Development Studies, Taylor & Francis Journals, vol. 55(1), pages 99-119, January.
    21. Arouri, Mohamed & Nguyen, Cuong & Youssef, Adel Ben, 2015. "Natural Disasters, Household Welfare, and Resilience: Evidence from Rural Vietnam," World Development, Elsevier, vol. 70(C), pages 59-77.
    22. Arthur Lewbel, 2012. "Using Heteroscedasticity to Identify and Estimate Mismeasured and Endogenous Regressor Models," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 30(1), pages 67-80.
    23. Chichaibelu, Bezawit Beyene & Waibel, Hermann, 2018. "Over-indebtedness and its persistence in rural households in Thailand and Vietnam," Journal of Asian Economics, Elsevier, vol. 56(C), pages 1-23.
    24. Kati Schindler, 2010. "Credit for What? Informal Credit as a Coping Strategy of Market Women in Northern Ghana," Journal of Development Studies, Taylor & Francis Journals, vol. 46(2), pages 234-253.
    25. Blundell, Richard & Bond, Stephen, 1998. "Initial conditions and moment restrictions in dynamic panel data models," Journal of Econometrics, Elsevier, vol. 87(1), pages 115-143, August.
    26. Mikkel Barslund & Finn Tarp, 2008. "Formal and Informal Rural Credit in Four Provinces of Vietnam," Journal of Development Studies, Taylor & Francis Journals, vol. 44(4), pages 485-503, April.
    27. Carmen Kislat, 2015. "Why are Informal Loans Still a Big Deal? Evidence from North-east Thailand," Journal of Development Studies, Taylor & Francis Journals, vol. 51(5), pages 569-585, May.
    28. Phung, T.D. & Hardeweg, B. & Praneetvatakul, S. & Waibel, H., 2015. "Non-Sampling Error and Data Quality: What Can We Learn from Surveys to Collect Data for Vulnerability Measurements?," World Development, Elsevier, vol. 71(C), pages 25-35.
    29. 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.
    30. Thanh-Tung Nguyen & Trung Thanh Nguyen & Ulrike Grote, 2020. "Credit and Ethnic Consumption Inequality in the Central Highlands of Vietnam," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 148(1), pages 143-172, February.
    31. 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.
    32. Nguyen, Trung Thanh & Nguyen, Loc Duc & Lippe, Rattiya Suddeephong & Grote, Ulrike, 2017. "Determinants of Farmers’ Land Use Decision-Making: Comparative Evidence From Thailand and Vietnam," World Development, Elsevier, vol. 89(C), pages 199-213.
    33. Sophie Mitra & Michael Palmer & Daniel Mont & Nora Groce, 2016. "Can Households Cope with Health Shocks in Vietnam?," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 888-907, July.
    34. Phatta Kirdruang & Paul Glewwe, 2018. "The impact of universal health coverage on households’ consumption and savings in Thailand," Journal of the Asia Pacific Economy, Taylor & Francis Journals, vol. 23(1), pages 78-98, January.
    35. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    36. Ha Thi Hong Nguyen & Sarah Bales & Adam Wagstaff & Huyen Dao, 2017. "Getting Incentives Right? The Impact of Hospital Capitation Payment in Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 263-272, February.
    37. Gabriella Berloffa & Sara Giunti, 2019. "Remittances and healthcare expenditure: Human capital investment or responses to shocks? Evidence from Peru," Review of Development Economics, Wiley Blackwell, vol. 23(4), pages 1540-1561, November.
    38. Manuel Arellano & Stephen Bond, 1991. "Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 58(2), pages 277-297.
    39. Kochar, Anjini, 1995. "Explaining Household Vulnerability to Idiosyncratic Income Shocks," American Economic Review, American Economic Association, vol. 85(2), pages 159-164, May.
    40. Lanjouw, Jean O. & Lanjouw, Peter, 2001. "The rural non-farm sector: issues and evidence from developing countries," Agricultural Economics, Blackwell, vol. 26(1), pages 1-23, October.
    41. 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.
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