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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.

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  • 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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    Cited by:

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    2. Acharya, Arnab & Vellakkal, Sukumar & Taylor Fiona & Masset Edoardo & Satija, Ambika & Burke, Margaret & Ebrahim, Shah, 2013. "The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review," Policy Research Working Paper Series 6324, The World Bank.
    3. Lin Lin & Xianhua Zai, 2022. "The role of supply responses in public insurance expansion: evidence from China's New Cooperative Medical Scheme," MPIDR Working Papers WP-2022-025, Max Planck Institute for Demographic Research, Rostock, Germany.
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    6. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.
    7. Yang, Feng-An & Chang, Hung-Hao, 2023. "Impact of a pension program on healthcare utilization among older farmers: Empirical evidence from health claims data," World Development, Elsevier, vol. 169(C).
    8. Jonah S. Goldberg, 2023. "What we measure when we measure the effects of user fees: a replication, reanalysis, and extension of Tanaka, 2014," Empirical Economics, Springer, vol. 65(4), pages 1981-2009, October.
    9. Ricardo Batista Politi, 2014. "Desigualdade Na Utilização De Serviçosde Saúde Entre Adultos: Uma Análise Dos Fatores De Concentração Dademanda," Anais do XL Encontro Nacional de Economia [Proceedings of the 40th Brazilian Economics Meeting] 220, ANPEC - Associação Nacional dos Centros de Pós-Graduação em Economia [Brazilian Association of Graduate Programs in Economics].
    10. 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.
    11. Clémentine Garrouste & Jérôme Le & Eric Maurin, 2011. "The choice of detecting Down syndrome: does money matter?," Health Economics, John Wiley & Sons, Ltd., vol. 20(9), pages 1073-1089, September.
    12. 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 and Oxford Review of Economic Policy Limited, vol. 32(1), pages 147-189.
    13. Phuong Hung Vu & Ardeshir Sepehri & Linh Thi Thuy Tran, 2023. "Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam’s Household Living Standard Survey 2006–2018," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 237-254, June.
    14. World Bank, 2015. "The Impact of Targeted Social Assistance on Labor Market in Georgia," World Bank Publications - Reports 22502, The World Bank Group.
    15. Garcia-Mandicó, Sílvia & Reichert, Arndt & Strupat, Christoph, 2021. "The Social Value of Health Insurance: Results from Ghana," Journal of Public Economics, Elsevier, vol. 194(C).
    16. Wagstaff, Adam & Eozenou, Patrick Hoang-Vu, 2014. "CATA meets IMPOV: a unified approach to measuring financial protection in health," Policy Research Working Paper Series 6861, The World Bank.
    17. Raj Panda & Pradeep Guin & Kumar Gaurav, 2020. "Governance in Public Purchasing of Tertiary-Level Health Care: Lessons From Madhya Pradesh, India," SAGE Open, , vol. 10(3), pages 21582440209, July.
    18. Jinghua Sun & Peng Cheng & Zhaoxu Liu, 2023. "Social Security, Intergenerational Care, and Cultivated Land Renting Out Behavior of Elderly Farmers: Findings from the China Health and Retirement Longitudinal Survey," Land, MDPI, vol. 12(2), pages 1-22, January.
    19. Ali, Shehzad & Cookson, Richard & Dusheiko, Mark, 2017. "Addressing care-seeking as well as insurance-seeking selection biases in estimating the impact of health insurance on out-of-pocket expenditure," Social Science & Medicine, Elsevier, vol. 177(C), pages 127-140.
    20. Sven Neelsen & Owen O'Donnell, 2017. "Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 179-203, December.
    21. Chatterjee, Chirantan & Joshi, Radhika & Sood, Neeraj & Boregowda, P., 2018. "Government health insurance and spatial peer effects: New evidence from India," Social Science & Medicine, Elsevier, vol. 196(C), pages 131-141.
    22. Salaheddine El Omari & Mahmoud Karasneh, 2021. "Social health insurance in the Philippines: do the poor really benefit?," Journal of Economics and Finance, Springer;Academy of Economics and Finance, vol. 45(1), pages 171-187, January.
    23. McBain, Florence, 2014. "Health insurance and health environment: India’s subsidized health insurance in a context of limited water and sanitation services," Working Papers 179200, University of Bonn, Center for Development Research (ZEF).
    24. Dai Su & Yingchun Chen & Hongxia Gao & Haomiao Li & Jingjing Chang & Shihan Lei & Di Jiang & Xiaomei Hu & Min Tan & Zhifang Chen, 2019. "Is There a Difference in the Utilisation of Inpatient Services Between Two Typical Payment Methods of Health Insurance? Evidence from the New Rural Cooperative Medical Scheme in China," IJERPH, MDPI, vol. 16(8), pages 1-16, April.
    25. Menezes-Filho, Naercio & Politi, Ricardo, 2020. "Estimating the causal effects of private health insurance in Brazil: Evidence from a regression kink design," Social Science & Medicine, Elsevier, vol. 264(C).

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