The Effects of Access to Health Insurance for Informally Employed Individuals in Peru

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. www.econstor.eu While it is commonly believed that this has positive effects, to date, it is not well understood through which channels health insurance coverage contributes to the well-being of individuals. More generally, the effects are usually not quantified at the individual level. There are two main reasons for this. First, we lack detailed data on health care utilization and health outcomes, and second, it is not easy to control for selection into insurance. The second problem means that a regression of utilization or outcome measures on insurance coverage will yield biased results and will not estimate the causal effects of health insurance. Terms of use: Documents in D I S C U S S I O N P A P E R S E R I E SIn this paper, we make progress in both directions. We use rich survey data to evaluate the impact of access to the Peruvian Social Health Insurance called "Seguro Integral de Salud" for individuals outside the formal labor market on a variety of measures for health care utilization, preventive care, health expenditures, and health indicators. We address the second concern by exploiting a fuzzy regression discontinuity design. A household is eligible for the program if a welfare index that is calculated from a number of variables is below a specific threshold. We base our analysis on a natural experiment that is generated by variation in the index around the threshold. We interpret our results through the lens of a simple model. As expected, and in contrast to studies for a number of other countries, we find strong effects of insurance coverage on measures of health care utilization, such as visiting a doctor, receiving medication and medical analysis. The program does not strongly incentivice individuals or health care providers to invest into preventive care. In line with this, in general, we find no effects of insurance coverage on preventive care. The only exceptions to this are our findings that, controlling for selection into insurance coverage, women of fertile age with insurance are more likely to receive pregnancy care and that insured individuals are more likely to be vaccinated. This is in line with the stark decrease in maternal and child mortality that was observed after the program was introduced. As for health care expenditures, we generally find positive effects on the mean and the variability. We complement these findings with quantile treatment effect estimates that show increases at the high end of the distribution. Our inte...

The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review

“…Among those 34 studies, 17 found a positive effect (i.e. a reduction in out-of-pocket expenditure), 15 studies found no statistically significant effect, and two studies–from Indonesia[59] and Peru[62]–reported a negative effect (i.e. an increase in out-of-pocket expenditure).…”

Progressive Universalism? The Impact of Targeted Coverage on Healthcare Access and Expenditures in Peru

“…However, lack of budgeting for the projected costs of delivering the benefit package, the continued exclusion of salary costs from the reimbursement rates, poor access to facilities in rural areas, manpower shortages, ineffective medicines procurement and widespread lack of inputs necessary for surgery mean that the service coverage actually available is likely to have fallen well short of that promised (Francke 2013;Vermeersch, Medici, and Narvaez 2014;Bernal, Carpio, and Klein 2015). Effective coverage of inpatient treatment was likely to have been particularly limited.…”

The Value of Socialized Medicine: The Impact of Universal Primary Healthcare Provision on Mortality Rates in Turkey

“…Importantly, their results do not show any improvements in health status. Bernal et al (2014) examine the impact of Peru's "Seguro Integral de Salud," which provides insurance coverage to individuals employed outside the formal labor market, on healthcare use and health indicators. Using a fuzzy regression discontinuity design to address the program endogeneity, the authors 9 They also examine the impact of the reform on supply-side responses and show that although the number of hospital beds went up, the number of medical institutions, physicians, and nurses did not seem to increase due to the reform.…”

“…Many countries have taken a primarily demand-side approach to extending health coverage, through mechanisms such as health insurance, user-fees on the basis of ability-to-pay, and conditional cash transfers, for example China (Carrin et al, 1999;Wagstaff et al, 2009), Colombia (Arroyave et al, 2013Giedion and Diaz, 2010;Ruiz et al, 2007), Costa Rica (Cercone et al, 2010;Dow and Schmeer, 2003), Mexico (Pfutze, 2014;Sosa-Rubi et al, 2009), Peru (Bernal et al, 2014;Bitrán et al, 2010), Taiwan (Cheng and Chiang, 1997), and Vietnam (Ekman et al, 2008;Somanathan 1 Opening remarks at a member state consultation on health in the post-2015 development agenda Geneva, Switzerland. , 2013).…”