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The impact of medical insurance for the poor in Georgia: a regression discontinuity approach

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  • Sebastian Bauhoff
  • David R. Hotchkiss
  • Owen Smith

Abstract

Improving access to health care and financial protection of the poor is a key concern for policymakers in low‐ and middle‐income countries, but there have been few rigorous program evaluations. The Medical Insurance Program for the Poor in the republic of Georgia provides a free and extensive benefit package and operates through a publicly funded voucher program, enabling beneficiaries to choose their own private insurance company. Eligibility is determined by a proxy means test administered to applicant households. The objective of this study is to evaluate the program's impact on key outcomes including utilization, financial risk protection, and health behavior and management. A dedicated survey of approximately 3500 households around the thresholds was designed to minimize unobserved heterogeneity by sampling clusters with both beneficiary and non‐beneficiary households. The research design exploits the sharp discontinuities at two regional eligibility thresholds to estimate local average treatment effects. Results suggest that the program did not affect utilization of health services but decreased mean out‐of‐pocket expenditures for some groups and reduced the risk of high inpatient expenditures. There are no systematic impacts on health behavior, management of chronic illnesses, and patient satisfaction. Copyright © 2010 John Wiley & Sons, Ltd.

Suggested Citation

  • Sebastian Bauhoff & David R. Hotchkiss & Owen Smith, 2011. "The impact of medical insurance for the poor in Georgia: a regression discontinuity approach," Health Economics, John Wiley & Sons, Ltd., vol. 20(11), pages 1362-1378, November.
    • Handle: RePEc:wly:hlthec:v:20:y:2011:i:11:p:1362-1378
    DOI: 10.1002/hec.1673
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    References listed on IDEAS

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    5. World Bank, 2009. "Georgia : Poverty assessment," World Bank Publications - Reports 3037, The World Bank Group.
    6. Hou, Xiaohui & Chao, Shiyan, 2008. "An evaluation of the initial impact of the medical assistance program for the poor in Georgia," Policy Research Working Paper Series 4588, The World Bank.
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