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Measuring the impact of health insurance with a correction for selection bias-a case study of Ecuador

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  • Hugh R. Waters

    (CRS-Peru, 209 W. Fayette St., Baltimore, USA)

Abstract

This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status. The setting for the study is the country of Ecuador. The General Health Insurance (GHI) programme, which primarily covers workers in the formal sector of the economy, is found to have a strong positive association with the use of curative health care after correcting for selection bias, but no significant effect on the use of preventive care. Individuals with severe illnesses who are eligible for GHI have a preference for private health care, and self-select out of the GHI programme. The Seguro Campesino Social (SSC) programme, directed at farming populations, has positive but insignificant associations with both curative and preventive care. Copyright © 1999 John Wiley & Sons, Ltd.

Suggested Citation

  • Hugh R. Waters, 1999. "Measuring the impact of health insurance with a correction for selection bias-a case study of Ecuador," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 473-483.
  • Handle: RePEc:wly:hlthec:v:8:y:1999:i:5:p:473-483
    DOI: 10.1002/(SICI)1099-1050(199908)8:5<473::AID-HEC453>3.0.CO;2-C
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    References listed on IDEAS

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    Cited by:

    1. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a low-income country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857.
    2. Wagstaff, Adam & Pradhan, Menno, 2005. "Health insurance impacts on health and nonmedical consumption in a developing country," Policy Research Working Paper Series 3563, The World Bank.
    3. Hugh R. Waters & Laurel E. Hatt & Robert E. Black, 2008. "The role of private providers in treating child diarrhoea in Latin America," Health Economics, John Wiley & Sons, Ltd., vol. 17(1), pages 21-29.
    4. Sosa-Rubí, Sandra G. & Galárraga, Omar & Harris, Jeffrey E., 2009. "Heterogeneous impact of the "Seguro Popular" program on the utilization of obstetrical services in Mexico, 2001-2006: A multinomial probit model with a discrete endogenous variable," Journal of Health Economics, Elsevier, vol. 28(1), pages 20-34, January.
    5. Sandra Hopkins & Michael P. Kidd & Aydogan Ulker, 2013. "Private Health Insurance Status and Utilisation of Dental Services in Australia," The Economic Record, The Economic Society of Australia, vol. 89(285), pages 194-206, June.
    6. Dekker, Marleen & Wilms, Annegien, 2010. "Health Insurance and Other Risk-Coping Strategies in Uganda: The Case of Microcare Insurance Ltd," World Development, Elsevier, vol. 38(3), pages 369-378, March.
    7. Gnawali, Devendra Prasad & Pokhrel, Subhash & Sié, Ali & Sanon, Mamadou & De Allegri, Manuela & Souares, Aurélia & Dong, Hengjin & Sauerborn, Rainer, 2009. "The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso," Health Policy, Elsevier, vol. 90(2-3), pages 214-222, May.
    8. Jeffrey E. Harris & Sandra G. Sosa-Rubi, 2009. "Impact of "Seguro Popular" on Prenatal Visits in Mexico, 2002-2005: Latent Class Model of Count Data with a Discrete Endogenous Variable," NBER Working Papers 14995, National Bureau of Economic Research, Inc.
    9. Sahoo, Anil Kumar & Madheswaran, S, 2014. "Healthcare utilisation behaviour in India: Socio-economic disparities & the effect of health insurance," Working Papers 317, Institute for Social and Economic Change, Bangalore.
    10. Sahoo, Amit Kumar & Madheswaran, S., 2014. "Out of pocket (OOP) financial risk protection: The role of health insurence," Working Papers 330, Institute for Social and Economic Change, Bangalore.
    11. Andrés Ramírez Hassan & Johnatan Cardona Jimenez & Ramiro Cadavid Montoya, 2011. "The impact of subsidized health insurance on the poor in Colombia: Evaluating the case of Medellin," DOCUMENTOS DE TRABAJO CIEF 010602, UNIVERSIDAD EAFIT.
    12. repec:spr:soinre:v:133:y:2017:i:2:d:10.1007_s11205-016-1371-9 is not listed on IDEAS
    13. Weiwei Feng & Wei Zhou & J.S. Butler & Brenda M. Booth & Michael T. French, 2001. "The impact of problem drinking on employment," Health Economics, John Wiley & Sons, Ltd., vol. 10(6), pages 509-521.
    14. Marty Makinen & Stephanie Sealy & Ricardo A. Bitrán & Sam Adjei & Rodrigo Muñoz, 2011. "Private Health Sector Assessment in Ghana," World Bank Publications, The World Bank, number 5956.
    15. 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.
    16. Likwang Chen & Winnie Yip & Ming-Cheng Chang & Hui-Sheng Lin & Shyh-Dye Lee & Ya-Ling Chiu & Yu-Hsuan Lin, 2007. "The effects of Taiwan's National Health Insurance on access and health status of the elderly," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 223-242.
    17. Jutting, Johannes P., 2004. "Do Community-based Health Insurance Schemes Improve Poor People's Access to Health Care? Evidence From Rural Senegal," World Development, Elsevier, vol. 32(2), pages 273-288, February.
    18. Matthew Jowett, 2004. "Theoretical insights into the development of health insurance in low-income countries," Working Papers 188chedp, Centre for Health Economics, University of York.
    19. Hamid, Syed Abdul & Roberts, Jennifer & Mosley, Paul, 2011. "Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from Bangladesh," World Development, Elsevier, vol. 39(3), pages 399-411, March.
    20. Lien Nguyen & Unto Häkkinen & Matti Knuuttila & Marjo-Riitta Järvelin, 2008. "Should we brush twice a day? Determinants of dental health among young adults in Finland," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 267-286.
    21. 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.
    22. Antonio J. Trujillo, 2003. "Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia," Health Economics, John Wiley & Sons, Ltd., vol. 12(3), pages 231-246.
    23. Adam Wagstaff, 2010. "Estimating health insurance impacts under unobserved heterogeneity: the case of Vietnam's health care fund for the poor," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 189-208.
    24. Layte, Richard & Nolan, Anne & McGee, Hannah & O'Hanlon, Ann, 2009. "Do consultation charges deter general practitioner use among older people? A natural experiment," Social Science & Medicine, Elsevier, vol. 68(8), pages 1432-1438, April.

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