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

Author

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  • Steven F. Koch

    () (Department of Economics, University of Pretoria)

  • Jeffrey S. Racine

    () (Department of Economics & Graduate Program in Statistics, Department of Mathematics, McMaster University, Hamilton, Ontario, Canada L8S 4M4)

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.

Suggested Citation

  • Steven F. Koch & Jeffrey S. Racine, 2013. "Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting," Working Papers 201353, University of Pretoria, Department of Economics.
  • Handle: RePEc:pre:wpaper:201353
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    References listed on IDEAS

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    2. repec:eee:econom:v:201:y:2017:i:1:p:1-18 is not listed on IDEAS
    3. 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.

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