Please use this identifier to cite or link to this item: http://hdl.handle.net/10419/142361
Authors: 
Woldemichael, Andinet
Gurara, Daniel Zerfu
Shimeles, Abebe
Year of Publication: 
2016
Series/Report no.: 
IZA Discussion Papers 9922
Abstract: 
In the absence of third party and prepayment systems such as health insurance and tax-based healthcare financing, households in many low-income countries are exposed to the financial risks of paying large medical bills from out-of-pocket. In recent years, community based health insurance schemes have become popular alternatives to fill such void in the healthcare financing systems. This paper investigates the impact of these schemes on out-of-pocket spending based on three rounds of nationally representative data from Rwanda. We estimate an Extended Two-Part Model to address endogeniety in insurance enrollment and censoring in healthcare expenditure data. We find that community based health insurance program has non-linear and mixed impacts on out-of-pocket expenditure. While the program significantly increases the probability of overall spending, it decreases the amount of per capita spending on healthcare. The program also significantly reduces spending on drug but increases outpatient spending with no detectable impact on inpatient services. Furthermore, we find notable heterogeneity in treatment effects in which households in the top income distribution realize the highest reduction in out-of-pocket spending.
Subjects: 
impact
health insurance
out-of-pocket
low-income
endogeneity
JEL: 
C21
C34
D04
I13
I15
Document Type: 
Working Paper

Files in This Item:
File
Size
369.26 kB





Items in EconStor are protected by copyright, with all rights reserved, unless otherwise indicated.