Risk Protection, Service Use, and Health Outcomes Under Colombia's Health Insurance Program for the Poor

Abstract

Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a "fuzzy" regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services -with measurable health gains.

Impact of Out of Pocket Health Expenditure on Consumption Pattern of Below Poverty Line Households in India

“…Unexpected illness is a leading source of economic risk (Miller, Pinto, & Vera-Herna´ndez, 2013). Financial expenditure incurred through illness are mainly financed from out of pocket in many developing countries including India.…”

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

“…Only 11 out of 154 LMICs channel at least 10% of their total health expenditure through private risk prepayment schemes and for most of these countries private for-profit schemes are generally limited to the wealthy minority [ 10 ]. Columbia and India are the only other LMICs described in the literature that have established a similar Public Private Partnership (PPP) for the insurance of the poor [ 11 , 12 ].…”

Regression discontinuity designs are underutilized in medicine, epidemiology, and public health: a review of current and best practice

“…Health effects of minimum legal drinking age De La Mata [35] 2012 Health Economics Effect of Medicaid eligibility on coverage, utilization, and health Deza [36] 2014 Health Economics Effect of alcohol use on drug consumption Flam-Zalcman et al [37] 2012 Intl J Psych Research Effect of criterion-based increase in alcohol treatment Fletcher [38] 2014 Biodemography and Social Biology Effect of genetics on stress response Glance et al [39] 2014 JAMA Surgery Effect of hospital report cards on mortality Gormley et al [40] 2005 Developmental Psychology Effect of universal pre-kindergarten on cognitive development Huang and Zhou [41] 2013 Social Science and Medicine Effect of education of cognition Jensen and Wust [42] 2014 Journal of Health Economics Effect of Caesarean section on maternal and child health McFarlane et al [43] 2014 Schizophrenia Bulletin Effect of treatment program on psychosis onset Miller et al [44] 2013 AEJ: Applied Economics Effect of insurance on health spending, utilization, and health Nishi et al [45] 2012 Bulletin of the WHO Health effects of patient cost-sharing Pierce et al [46] 2012 Pers Soc Psych Bulletin Effect of income disparity in marriage Sloan and Hanrahan [47] 2014 JAMA Ophthalmology Effect of new therapies on vision loss among elderly patients Smith et al [48] 2014 Canadian Medical Association Journal Effect of HPV vaccine on sexual behavior Sood et al [49] 2014 BMJ Effect of health insurance on mortality Weaver et al [50] 2010 Journal of Traumatic Stress Effect of cognitive-behavioral therapy on trauma symptoms Y€ or€ uk and Y€ or€ uk [51] 2012 Social Science and Medicine Effect of alcohol on psychological well-being included a discussion of the assignment rule and most included a discussion of the RD validity conditions. The most commonly omitted element was a histogram (or description of the distribution) of the assignment variable (25 of 32 omitted).…”

“…Miller et al [44] 2013 U U U U U 5 Nishi et al [45] 2012 ✗ U ✗ ✗ ✗ 2 Pierce et al [46] 2012 U U U ✗ U 5 Sloan and Hanrahan [47] 2014 ✗ U U ✗ ✗ 2 Smith et al [48] 2014 U U U ✗ U 4 Sood et al [49] 2014 U U U ✗ U 4 Weaver et al [50] 2010 ✗ U U ✗ ✗ 3 Y€ or€ uk and Y€ or€ uk [51] 2012 U U U ✗ U 4…”