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Zazdravnykh E, Aistov A, Aleksandrova E. Total expenditure elasticity of spending on self-treatment and professional healthcare: a case of Russia. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:81-105. [PMID: 37022649 DOI: 10.1007/s10754-023-09353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
The studies on the demand for healthcare in low- and middle-income countries rarely take into consideration the fact that many people spend their income on self-treatment and professional treatment. The estimation of the income elasticity of demand for self-treatment and professional treatment can show a more precise picture of the affordability of professional care. This paper contributes to the discussion around estimates of income elasticity of health spending and discussion whether professional care and self-treatment are close to a luxury good and inferior good respectively in a middle-income country. We apply the switching regression model to explain the choice between self-treatment and professional healthcare via estimates of the income elasticity. Estimates are made with the use of the Russian Longitudinal Monitoring Survey - Higher School of Economics (RLMS-HSE), a nationally representative survey. While individual expenditure on professional treatment is higher than that on self-treatment, our estimates show that expenses on professional treatment can be income inelastic except when spending on medicines prescribed by a physician that are elastic. The results also indicate that cost of self-treatment is income elastic. In all cases, the considered income elasticities are statistically insignificant between professional and self-treatment.
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Affiliation(s)
- Evguenii Zazdravnykh
- Evguenii Zazdravnykh, HSE University, Saint Petersburg, Russia.
- Graduate School of Management, St. Petersburg University, Saint-Petersburg, Russia.
| | - Andrey Aistov
- Andrey Aistov, HSE University, Niznhy Novgorod, Russia
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Nugraheni DA, Satibi S, Kristina SA, Puspandari DA. Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15017. [PMID: 36429734 PMCID: PMC9690347 DOI: 10.3390/ijerph192215017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND National Health Insurance (NHI) in Indonesia requires an appropriate cost-sharing policy, particularly for diseases that require the largest financing. This study examined factors that influence willingness to pay (WTP) for cost-sharing under the universal health coverage scheme among patients with catastrophic illnesses in Yogyakarta, Indonesia. METHODS This was a cross-sectional study using structured questionnaires through direct interviews. The factors related to the WTP for cost-sharing under the NHI scheme in Indonesia were identified by a bivariable logistic regression analysis. RESULTS Two out of every five (41.2%) participants had willingness to pay for cost-sharing. Sex [AOR = 0.69 (0.51, 0.92)], education [AOR = 1.54 (0.67, 3.55)], family size [AOR = 1.71 (1.07, 2.73)], occupation [AOR = 1.35 (0.88, 2.07)], individual income [AOR = 1.50 (0.87, 2.61)], household income [AOR = 1.47 (0.90, 2.39)], place of treatment [AOR = 2.54 (1.44, 4.45)], a health insurance plan [AOR = 1.22 (0.87, 1.71)], and whether someone receives an inpatient or outpatient service [AOR = 0.23 (0.10, 0.51)] were found to affect the WTP for a cost-sharing scheme with p < 0.05. CONCLUSION Healthcare (place of treatment, health insurance plan, and whether someone receives an inpatient or outpatient service) and individual socioeconomic (sex, educational, family size, occupational, income) factors were significantly related to the WTP for cost-sharing.
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Affiliation(s)
- Diesty Anita Nugraheni
- Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
| | - Satibi Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Diah Ayu Puspandari
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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Pushpalata Zanwar P, Perianayagam A, Zazdravnykh E, Omar Z, Vinod Joseph KJ, Santos FH, Negm AM, Reistetter TA, Heyn PC, Kelekar U. Examining the Impacts of Coronavirus Disease 2019 Mitigation Policies on Health Outcomes of Older Adults: Lessons Learned From Six High-Income or Middle-Income Countries. THE PUBLIC POLICY AND AGING REPORT 2022; 32:121-130. [PMID: 36349280 PMCID: PMC9619694 DOI: 10.1093/ppar/prac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Preeti Pushpalata Zanwar
- Address correspondence to: Preeti Zanwar, PhD, MPH, MS, Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, Pennsylvania, 19107, USA.
| | - Arokiasamy Perianayagam
- International Institute for Population Sciences, Mumbai, India,National Council of Applied Economic Research (NCAER), Delhi, India
| | - Evguenii Zazdravnykh
- Department of Management, International Centre of Health Economics, Policy, and Management, HSE University, St. Petersburg, Russia
| | - Zaliha Omar
- Department of Rehabilitation Medicine, Fujita Health University, Toyoake, Aichi, Japan,Department of Rehabilitation Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - K J Vinod Joseph
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Flavia H Santos
- Centre for Disability Studies, University College Dublin, Ireland
| | - Ahmed M Negm
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Timothy A Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Patricia C Heyn
- Marymount Center for Optimal Aging, Marymount University, Arlington, Virginia, USA
| | - Uma Kelekar
- Marymount Center for Optimal Aging, Marymount University, Arlington, Virginia, USA,School of Business, Innovation, Leadership and Technology, Marymount University, Arlington, Virginia, USA
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Aistov A, Aleksandrova E, Gerry CJ. Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:281-309. [PMID: 33367963 PMCID: PMC7757736 DOI: 10.1007/s10198-020-01252-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
This paper contributes to the discussion around ex-post (increased utilisation of health care) and ex-ante (changes in health behaviours) moral hazard in supplemental private health insurance. Applying a range of methodologies to data from the Russian Longitudinal Monitoring Survey-Higher School of Economics we exploit a selection mechanism in the data to compare the impact of workplace provided and individually purchased supplemental health insurance on the utilisation of health care, on a range of health behaviours and on self-assessed health. We find compelling policy-relevant evidence of ex-post moral hazard that confirms a theoretical prediction and empirical regularity found in other settings. In contrast to other empirical findings though, our data reveals evidence of ex-ante moral hazard demonstrated by clear behavioural differences between those with self-funded supplemental health insurance and those for whom the workplace finances the additional insurance. We find no evidence that either form of insurance is related to improved self-assessed health.
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Affiliation(s)
- Andrey Aistov
- National Research University Higher School of Economics, Nizhny Novgorod, Russian Federation
- Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, St. Petersburg, Russian Federation
| | - Ekaterina Aleksandrova
- Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, St. Petersburg, Russian Federation
| | - Christopher J Gerry
- Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, St. Petersburg, Russian Federation.
- Oxford School of Global and Area Studies, University of Oxford, Oxford, England.
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Kaneva M, Gerry CJ, Avxentiev N, Baidin V. Attitudes to reform: Could a cooperative health insurance scheme work in Russia? INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2019; 19:371-394. [PMID: 30671697 DOI: 10.1007/s10754-019-09260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
As for all health systems, in Russia, the demand for medical care is greater than its health system is able to guarantee the supply of. In this context, removing services from the state guaranteed package is an option that is receiving serious consideration. In this paper, we examine the attitudes of the Russian population to such a reform. Exploiting a widely-used methodology, we explore the population's willingness to pay for cooperative health insurance. Distinguishing between socioeconomic and demographic factors, health-related indicators and risk aversion we find, consistent with other literature, positive income and risk aversion effects. We interpret the former as evidence that the Russian population is not opposed to the idea of progressive redistribution, to pool the costs of health-related risks; and the latter as evidence that risk-averse individuals demand more insurance coverage. In exploring these results further, we show that cognitive bias is important: overestimating the benefits leads to the purchase of additional insurance, while underestimating lowers demand for insurance. Our overall conclusion is that the introduction of a supplementary cooperative health insurance scheme in Russia could increase the accessibility of healthcare, lower the tendency for informal payments, incentivize the personal maintenance of good health and create a new source of funding for public healthcare.
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Affiliation(s)
- Maria Kaneva
- International Laboratory for Healthcare Economics and Its Reforms, Gaidar Institute for Economic Policy, Gazetny Pereulok 3-5, Building 1, Office 471, Moscow, Russia, 125993.
- Institute of Economics and Industrial Engineering, Siberian Branch of the Russian Academy of Sciences, 17 Ac. Lavrentieva Prospekt, office 373, Novosibirsk, Russia, 630090.
| | - Christopher J Gerry
- Oxford School of Global and Area Studies (OSGA), University of Oxford, 12 Bevington Road, Oxford, OX2 6LH, UK
| | - Nikolay Avxentiev
- Institute for Social Analysis and Forecasting of The Russian Presidential Academy of National Economy and Public Administration (ISAF RANEPA), Prechistenskaya Naberezhnaya 11, Moscow, Russia, 119034
- Center for Perspective Financial Planning, Macroeconomic Analysis and Financial Statistics, Financial Research Institute of Ministry of Finance, Nastasyinsky Pereulok 3, Building 2, Office 110, Moscow, Russia, 127006
| | - Valerii Baidin
- Center for Fiscal Policy, Financial Research Institute of Ministry of Finance, Nastasyinsky Pereulok 3, Building 2, Office 101, Moscow, Russia, 127006
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