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The impact of private health insurers on the quality of Russian regional health systems

Author

Listed:
  • Galina Besstremyannaya

    () (Center for Economic and Financial Research at New Economic School)

  • Jaak Simm

    (Tokyo Institute of Technology, Graduate School of Information Science and Engineering)

Abstract

The 1991 law ‘On health insurance for the citizens of the Russian Federation’ established that social health insurance is to be offered by multiple private insurance companies. The paper is the first econometric analysis measuring the effect of private health insurers on quality related outcomes of social health insurance (SHI) systems in Russian regions. The baseline model introduces regional SHI system as a binary variable with unity value corresponding to the presence of private health insurers as the only agents at the SHI market. The extended model captures endogeneity by employing an instrumental variable approach. The non-parametric model uses kernel regressions. The results of parametric and kernel regressions reveal that the presence of private insurers is a significant determinant of infant and under-five mortality. The positive impact of private insurers is explained by regional institutional reforms. The methods of provider reimbursement are related to infant and under-five mortality, which offers suggestive evidence for enabling insurer competition through selective contracting with health care providers.

Suggested Citation

  • Galina Besstremyannaya & Jaak Simm, 2012. "The impact of private health insurers on the quality of Russian regional health systems," Working Papers w0177, Center for Economic and Financial Research (CEFIR).
  • Handle: RePEc:cfr:cefirw:w0177
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    File URL: http://www.cefir.ru/papers/WP_177.pdf
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    References listed on IDEAS

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    1. Hardle, Wolfgang & Linton, Oliver, 1986. "Applied nonparametric methods," Handbook of Econometrics,in: R. F. Engle & D. McFadden (ed.), Handbook of Econometrics, edition 1, volume 4, chapter 38, pages 2295-2339 Elsevier.
    2. Bidani, Benu & Ravallion, Martin, 1997. "Decomposing social indicators using distributional data," Journal of Econometrics, Elsevier, vol. 77(1), pages 125-139, March.
    3. Racine, Jeff & Li, Qi, 2004. "Nonparametric estimation of regression functions with both categorical and continuous data," Journal of Econometrics, Elsevier, vol. 119(1), pages 99-130, March.
    4. Isabelle Joumard & Christophe André & Chantal Nicq, 2010. "Health Care Systems: Efficiency and Institutions," OECD Economics Department Working Papers 769, OECD Publishing.
    5. repec:aph:ajpbhl:1998:88:5:755-758_5 is not listed on IDEAS
    6. Guillem Lopez-Casasnovas & Joan Costa-Font & Ivan Planas, 2005. "Diversity and regional inequalities in the Spanish 'system of health care services'," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 221-235.
    7. Hsiao, Cheng & Li, Qi & Racine, Jeffrey S., 2007. "A consistent model specification test with mixed discrete and continuous data," Journal of Econometrics, Elsevier, vol. 140(2), pages 802-826, October.
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    More about this item

    Keywords

    social health insurance; infant mortality; under-five mortality; kernel regression; health care systems; health care quality; provider payment;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • R22 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Household Analysis - - - Other Demand

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