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Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting

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  • Steven F. Koch
  • Jeffrey S. Racine

Abstract

We apply parametric and nonparametric regression discontinuity methodology within a multinomial choice setting to examine the impact of public health care user fee abolition on health facility choice using data from South Africa. The nonparametric model is found to outperform the parametric model both in- and out-of-sample, while also delivering more plausible estimates of the impact of user fee abolition (i.e. the 'treatment effect'). In the parametric framework, treatment effects were relatively constant - around 7% - and that increase was drawn equally from both home care and private care groups. On the other hand, in the nonparametric framework treatment effects were largest for the least well-off (also around 7%) but fell for the most well-off. More plausibly, that increase was drawn primarily from the home care group, suggesting that the policy favoured those least well-off as more of these children received at least some minimum level of professional health care after the policy was implemented. Regarding the most well-off, despite having access to free public health care, children were still far more likely to receive health care at private facilities than at public facilities, which is also more plausible in South Africa's two-tier health sector.

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  • Steven F. Koch & Jeffrey S. Racine, 2013. "Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting," Department of Economics Working Papers 2013-14, McMaster University.
  • Handle: RePEc:mcm:deptwp:2013-14
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    1. Steven F. Koch & Naomi Setshegetso, 2021. "Progressivity of out-of-pocket payments and its determinants decomposed over time," Development Southern Africa, Taylor & Francis Journals, vol. 38(5), pages 731-749, September.
    2. Steven F. Koch, 2017. "User Fee Abolition and the Demand for Public Health Care," South African Journal of Economics, Economic Society of South Africa, vol. 85(2), pages 242-258, June.
    3. Xu, Ke-Li, 2017. "Regression discontinuity with categorical outcomes," Journal of Econometrics, Elsevier, vol. 201(1), pages 1-18.
    4. Cory Koedel & Jiaxi Li & Matthew G. Springer & Li Tan, 2016. "The Impact of Performance Ratings on Job Satisfaction for Public School Teachers," Working Papers 1617, Department of Economics, University of Missouri.
    5. Aistov, Andrey, 2019. "Happy together: A regression discontinuity approach," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 53, pages 73-99.

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