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Li Y, Li L, Liu J. The impact of health insurance on self-protection of Chinese rural residents. Front Public Health 2022; 10:874619. [PMID: 36187632 PMCID: PMC9523309 DOI: 10.3389/fpubh.2022.874619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/29/2022] [Indexed: 01/21/2023] Open
Abstract
Purpose Health insurance lowers the price of medical services, which reduces the insured's demand for self-protection (such as, live a healthy lifestyle or invest in disease prevention) that could help reduce the probability of getting sick, then ex ante moral hazard happens. The purpose of this study is to examine the impact and its heterogeneity of health insurance on the self-protection of Chinese rural residents. Method This study firstly builds a theoretical model of health insurance and self-protection. Then, based on the data from the 2004 to 2015 China Health and Nutrition Survey (CHNS), we adopt ordinary least squares model (OLS), probit model, and instrumental variable (IV) method to empirically investigate the impact of health insurance on Chinese rural residents' self-protection. Results After addressing the endogeneity problem, the study finds that participating in health insurance exerts a significant negative impact on the demand for self-protection. Specifically, health insurance participation not only increases residents' tendency toward drinking liquor by 3.4%, and that of having general obesity by 3.7%, but also reduces residents' preventive medical expenditure (PME) by 1.057%, increasing Body Mass Index (BMI) by 0.784 kg/m2. Further analysis shows that there is heterogeneity between groups, as health insurance participation reduces PME of people who are female, younger, and high-educated, and increases the tendency toward drinking liquor of people who are younger and low-educated. Conclusions To reduce the impact of ex ante moral hazard induced by health insurance, our findings suggest that it is necessary to improve the disease prevention function of health insurance and introduce a risk adjustment mechanism into the premium or co-payment design of health insurance.
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Affiliation(s)
- Yao Li
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Lei Li
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China,*Correspondence: Lei Li
| | - Junxia Liu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Estimating heterogeneous policy impacts using causal machine learning: a case study of health insurance reform in Indonesia. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021. [DOI: 10.1007/s10742-021-00259-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractPolicymakers seeking to target health policies efficiently towards specific population groups need to know which individuals stand to benefit the most from each of these policies. While traditional approaches for subgroup analyses are constrained to only consider a small number of pre-defined subgroups, recently proposed causal machine learning (CML) approaches help explore treatment-effect heterogeneity in a more flexible yet principled way. Causal forests use a generalisation of the random forest algorithm to estimate heterogenous treatment effects both at the individual and the subgroup level. Our paper aims to explore this approach in the setting of health policy evaluation with strong observed confounding, applied specifically to the context of mothers’ health insurance enrolment in Indonesia. Comparing two health insurance schemes (subsidised and contributory) against no insurance, we find beneficial average impacts of enrolment in contributory health insurance on maternal health care utilisation and infant mortality, but no impact of subsidised health insurance. The causal forest algorithm identified significant heterogeneity in the impacts of contributory insurance, not just along socioeconomic variables that we pre-specified (indicating higher benefits for poorer, less educated, and rural women), but also according to some other characteristics not foreseen prior to the analysis, suggesting in particular important geographical impact heterogeneity. Our study demonstrates the power of CML approaches to uncover unexpected heterogeneity in policy impacts. The findings from our evaluation of past health insurance expansions can potentially guide the re-design of the eligibility criteria for subsidised health insurance in Indonesia.
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Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda. Soc Sci Med 2019; 245:112738. [PMID: 31855728 DOI: 10.1016/j.socscimed.2019.112738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 01/07/2023]
Abstract
While community-based health insurance increasingly becomes part of the health financing landscape in developing countries, there is still limited research about its impacts on health outcomes. Using cross-sectional data from rural south-western Uganda, we apply a two-stage residual inclusion instrumental variables method to study the impact of insurance participation on child stunting in under-five children. We find that one year of a household's participation in community-based health insurance was associated with a 4.3 percentage point less probability of stunting. Children of two years or less dominated the effect but there were also statistically significant benefits of enrolling in insurance after a child's birth. The expansion of community-based health insurance might have more dividends to improving health, in addition to financial protection and service utilisation in rural developing countries.
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Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0219731. [PMID: 31461458 PMCID: PMC6713352 DOI: 10.1371/journal.pone.0219731] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. METHODS We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. FINDINGS 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.
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Affiliation(s)
- Darius Erlangga
- Department of Health Sciences, University of York, York, England, United Kingdom
| | - Marc Suhrcke
- Centre of Health Economics, University of York, York, England, United Kingdom
- Luxembourg Institute of Socio-economic Research (LISER), Luxembourg
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England, United Kingdom
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karen Bloor
- Department of Health Sciences, University of York, York, England, United Kingdom
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Fu R, Noguchi H. Moral hazard under zero price policy: evidence from Japanese long-term care claims data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:785-799. [PMID: 30868381 DOI: 10.1007/s10198-019-01041-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
We evaluate the presence and magnitude of moral hazard in Japan's public long-term care insurance (LTCI) market. Using monthly LTCI claim records from January 2006 to December 2015 linked to concurrent death records, we construct a sample by propensity score matching insured individuals who co-pay 10% of their fees to those with no required copayments, and we implement fixed-effect estimations. We find that a ten-percentage-point reduction in the copayment rate increases monthly costs by 10.2 thousand yen, corresponding to a price elasticity of about - 0.1. Insured individuals with no copayments tend to use more services and have more utilization days than those with copayments do. Furthermore, we find that insured individuals who die from cerebral (myocardial) infarction increase their service use more in response to a reduction in the copayment rate than those who die from senility do, indicating a positive association between ex-ante health risks and ex-post service use. We verify that a cost-sharing adjustment is a valid solution for soaring LTCI expenditures. These findings could provide broad implications for the rapidly aging world.
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Affiliation(s)
- Rong Fu
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku-ku, Tokyo, 169-8050, Japan.
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku-ku, Tokyo, 169-8050, Japan
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Fernando R, Leticia AB, Antonio J T. How does managed competition affect hospital prices in a social health insurance system? The Colombian case. Health Policy Plan 2019; 33:1037-1046. [PMID: 30462221 DOI: 10.1093/heapol/czy085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
This paper studies the effect on hospital service prices of a health system reform that allows managed selective contracting and regulation as a means for efficiency and price competition. Cross-sectional data about prices and market structure were analysed from a pool of 20 markets which includes 15 million Colombians. A multilevel regression method comparing three different market settings was performed. The analysis evaluates the effects of insurer choice, hospital quality and market characteristics using a nationwide health services transactional database. A Hirshmann-Herfindahl index was applied to evaluate the markets concentration. Among the results, bilateral monopolies were made evident, both in insurance and hospital markets. Insurer selective contracting policy has the greatest impact on pricing with hospital monopoly heavy effect on health service prices. Colombian government has a challenge in regulating managed competition in order to maintain competition and access to healthcare. Health reforms using market competition as a mechanism for efficiency should follow closely health services market evolution in order to introduce effective regulatory policies.
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Affiliation(s)
- Ruiz Fernando
- Centro de Tratamiento e Investigación sobre Cancer Luis Carlos Sarmiento Angulo (CTIC) Carrera 13 # 26a 47 Floor 27th and Processum SAS Carrera 19 # 114 09 Of. 403, Bogota, Colombia
| | - Avila-Burgos Leticia
- Instituto Nacional de Salud Publica de Mexico, Centro de Investigacion en Sistemas de Salud (CISS), Universidad # 655 Colonia Santa Maria Ahuacatitlan, Cerrada los Pinos y Caminera C.P., Cuernavaca, Morelos, México and
| | - Trujillo Antonio J
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Dong W, Gao J, Zhou Z, Bai R, Wu Y, Su M, Shen C, Lan X, Wang X. Effects of China's urban basic health insurance on preventive care service utilization and health behaviors: Evidence from the China Health and Nutrition Survey. PLoS One 2018; 13:e0209890. [PMID: 30596751 PMCID: PMC6312240 DOI: 10.1371/journal.pone.0209890] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Lifestyle choices are important determinants of individual health. Few studies have investigated changes in health behaviors and preventive activities brought about by the 2007 implementation of Urban Resident Basic Health Insurance (URBMI) in China. This study, therefore, aimed to explore whether URBMI has reduced individuals’ incentives to adopt healthy behaviors and utilize preventive care services. Methods Data were drawn from two waves of the China Health and Nutrition Survey. Respondents were categorized according to their insurance situation before and after the URBMI reform in 2006 and 2011. Propensity score matching and difference-in-differences methods were used to measure levels of preventive care and behavior changes over time. Estimations were also made based on gender, self-reported health, and income. Results We found that URBMI implementation did not change residents’ utilization of preventive care services or their smoking habits, drinking habits, or other risky behaviors overall. However, the likelihood of sedentariness did increase by five percentage points. Females tended to be more sedentary while males were less likely to drink soft drinks. Residents with poor self-reported health exercised less while those who reported good health were more likely to be sedentary. Low- and middle-income residents were likely to be sedentary while middle-income people tended to smoke after becoming insured. Conclusion Since URBMI implementation, some unhealthy behaviors like sedentariness have increased among those who were newly insured, and different subgroups have reacted differently. This suggests that the insurance design needs to be optimized and effective measures need to be adopted to help improve people’s lifestyle choices.
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Affiliation(s)
- Wanyue Dong
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail:
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ruhai Bai
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Yue Wu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Min Su
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Lan
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xiao Wang
- International Business School Suzhou, Xi’an Jiaotong-Liverpool University, Suzhou, Jiangsu, People’s Republic of China
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Yu NN, Zhu X. Affordable care encourages healthy living: Theory and evidence from China's new cooperative medical scheme. HEALTH ECONOMICS 2018; 27:2051-2066. [PMID: 30126021 DOI: 10.1002/hec.3820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 01/28/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
In developing a theory of medical insurance and health behavior with bequest motive, we discover that whether ex ante moral hazard or the opposite occurs hinges upon the differential effects of health behavior on morbidity and mortality. Providing insurance can encourage healthy living by making longevity more affordable. We test the theory utilizing a unique experiment of China introducing the new cooperative medical scheme, unique in its long-term credibility necessary for our proposed channel. This scheme reduced cigarette use by around 9%. Further empirical analysis failed to falsify our theory or the alternative mechanism of health insurance reducing stress and thus the demand for cigarettes and hard liquor. Both newly proposed mechanisms alleviate concerns over ex ante moral hazard caused by providing affordable care for the poor.
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Affiliation(s)
- Ning Neil Yu
- School of Economics, Nanjing Audit University, Nanjing, China
- Rural Education Action Program, Stanford University Freeman Spogli Institute for International Studies, Stanford, California
| | - Xi Zhu
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
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Knox M. Creating a preference for prevention: the role of universal health care in the demand for preventive care among Mexico's vulnerable populations. Health Policy Plan 2018; 33:853-860. [PMID: 31222331 DOI: 10.1093/heapol/czy062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/12/2022] Open
Abstract
The introduction of Seguro Popular (SP)- providing health insurance to over 50 million Mexicans since the early 2000s-represents a large shift in health care delivery to the Mexican population. And yet, its impact on Mexico's marginalized communities has been little studied, and its impact on health is unclear. Using a survey of poor urban Mexicans and Mexican Ministry of Health administrative data, this article investigates SP's effect on those at the most risk for health disparities by looking at the impact of the programme on demand for preventive care services, especially among women, children and the indigenous. Three outcomes important to Mexico's burden of disease are explored: general physical exams, diabetes screening, and cervical cancer screening. Ordinary least square regressions show that the introduction of SP is associated with an increase in demand for all three services, but these results are likely biased due to selection into the programme. I then use the staggered geographic roll out of SP between 2004 and 2007 to identify the causal impact of the programme on demand. I use length of exposure to SP as an instrumental variable to predict SP affiliation in 2009. Two stage least squares estimates of the causal impact of SP on demand for preventive care services finds that SP affiliation increases adult demand for physicals, but does not affect demand for diabetes screening. Additionally, I find that female and child SP affiliates are less likely to demand physicals, while affiliates who identify as indigenous are less likely to demand physicals but more likely to demand cervical cancer screenings.
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Affiliation(s)
- Melissa Knox
- Department of Economics, University of Washington, Box 353330, 305 Savery Hall, Seattle, USA
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Lee ES, Vedanthan R, Jeemon P, Kamano JH, Kudesia P, Rajan V, Engelgau M, Moran AE. Quality Improvement for Cardiovascular Disease Care in Low- and Middle-Income Countries: A Systematic Review. PLoS One 2016; 11:e0157036. [PMID: 27299563 PMCID: PMC4907518 DOI: 10.1371/journal.pone.0157036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The majority of global cardiovascular disease (CVD) burden falls on people living in low- and middle-income countries (LMICs). In order to reduce preventable CVD mortality and morbidity, LMIC health systems and health care providers need to improve the delivery and quality of CVD care. OBJECTIVES As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality improvement, we reviewed and summarized currently available evidence on interventions to improve quality of clinic-based CVD prevention and management in LMICs. METHODS We conducted a narrative review of published comparative clinical trials that evaluated efficacy or effectiveness of clinic-based CVD prevention and management quality improvement interventions in LMICs. Conditions selected a priori included hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, rheumatic heart disease, and congestive heart failure. MEDLINE and EMBASE electronic databases were systematically searched. Studies were categorized as occurring at the system or patient/provider level and as treating the acute or chronic phase of CVD. RESULTS From 847 articles identified in the electronic search, 49 met full inclusion criteria and were selected for review. Selected studies were performed in 19 different LMICs. There were 10 studies of system level quality improvement interventions, 38 studies of patient/provider interventions, and one study that fit both criteria. At the patient/provider level, regardless of the specific intervention, intensified, team-based care generally led to improved medication adherence and hypertension control. At the system level, studies provided evidence that introduction of universal health insurance coverage improved hypertension and diabetes control. Studies of system and patient/provider level acute coronary syndrome quality improvement interventions yielded inconclusive results. The duration of most studies was less than 12 months. CONCLUSIONS The results of this review suggest that CVD care quality improvement can be successfully implemented in LMICs. Most studies focused on chronic CVD conditions; more acute CVD care quality improvement studies are needed. Longer term interventions and follow-up will be needed in order to assess the sustainability of quality improvement efforts in LMICs.
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Affiliation(s)
- Edward S. Lee
- Department of Medicine, Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America
| | - Rajesh Vedanthan
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Panniyammakal Jeemon
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Kerala, India
| | - Jemima H. Kamano
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Preeti Kudesia
- Health, Nutrition and Population Global Practice, The World Bank, Kathmandu, Nepal
| | | | - Michael Engelgau
- Center for Translation Research and Implementation Science, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Andrew E. Moran
- Department of Medicine, Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
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11
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Abstract
Objective: While the education gradient in prevention of chronic conditions is well documented, contributing factors remain underexplored. The contribution of income, knowledge and management of illness, market prices, cognitive ability, ability to act, perception about the future, and psychosocial constraints to the education gradient in prevention is examined. Methods: To solve problems of unobservable factors that influence prevention and illness severity, we estimate the role of each component of the education gradient on prevention using data on diabetes and hypertension from five Latin American countries. Results: Overall, these components explain 50% to 70% of the education gradient in prevention, with income being the most important. Discussion: Cognitive ability and ability to act capture an important part of the education gradient in prevention whereas knowledge about illness explains little. Medicine individualized to patients’ cognitive ability and ability to act could improve adherence to prevention protocols among patients with chronic conditions.
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Affiliation(s)
| | - Lisa K. Fleisher
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Buttorff C, Trujillo AJ, Ruiz F, Amaya JL. Low rural health insurance take-up in a universal coverage system: perceptions of health insurance among the uninsured in La Guajira, Colombia. Int J Health Plann Manage 2013; 30:98-110. [DOI: 10.1002/hpm.2209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/11/2013] [Accepted: 06/17/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Christine Buttorff
- Department of Health Policy and Management; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Antonio J. Trujillo
- Department of International Health; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
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14
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Yilma Z, van Kempen L, de Hoop T. A perverse 'net' effect? Health insurance and ex-ante moral hazard in Ghana. Soc Sci Med 2012; 75:138-47. [PMID: 22507951 DOI: 10.1016/j.socscimed.2012.02.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 02/20/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
Incentive problems in insurance markets are well-established in economic theory. One of these incentive problems is related to reduced prevention efforts following insurance coverage (ex-ante moral hazard). This prediction is yet to be tested empirically with regard to health insurance, as the health domain is often considered relatively immune to perverse incentives, despite its validation in other insurance markets that entail adverse shocks. This paper tests for the presence of ex-ante moral hazard with reference to malaria prevention in Ghana. We investigate whether enrollment in the country's National Health Insurance Scheme (NHIS) negatively affects ownership and use of insecticide-treated bed nets (ITNs). We use a panel of 400 households in the Brong Ahafo region for this purpose and employ a propensity-adjusted household fixed effects model. Our results suggest that ex-ante moral hazard is present, especially when the level of effort and cost required for prevention is high. Implications of perverse incentive effects for the NHIS are briefly outlined.
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Affiliation(s)
- Zelalem Yilma
- International Institute of Social Studies, Erasmus University Rotterdam, The Netherlands.
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Glassman A, Gaziano TA, Bouillon Buendia CP, Guanais de Aguiar FC. Confronting The Chronic Disease Burden In Latin America And The Caribbean. Health Aff (Millwood) 2010; 29:2142-8. [DOI: 10.1377/hlthaff.2010.1038] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amanda Glassman
- Amanda Glassman ( ) is director of the Global Health Policy Program at the Center for Global Development, in Washington, D.C
| | - Thomas A. Gaziano
- Thomas A. Gaziano is a physician at Brigham and Women’s Hospital and Harvard Medical School, in Boston, Massachusetts
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