The Impact of Medical Insurance for the Poor in Georgia: A Regression Discontinuity Approach

Health Economics, October 2010

Posted: 20 Mar 2011

See all articles by Sebastian Bauhoff

Sebastian Bauhoff

Center for Global Development

David Hotchkiss

Tulane University - School of Public Health and Tropical Medicine

Owen Smith

affiliation not provided to SSRN

Date Written: October 14, 2010

Abstract

Improving access to health care and financial protection of the poor is a key concern for policymakers in low- and middle-income countries, but there have been few rigorous program evaluations. The Medical Insurance Program for the Poor in the republic of Georgia provides a free and extensive benefit package and operates through a publicly funded voucher program, enabling beneficiaries to choose their own private insurance company. Eligibility is determined by a proxy means test administered to applicant households. The objective of this study is to evaluate the program's impact on key outcomes including utilization, financial risk protection, and health behavior and management. A dedicated survey of approximately 3500 households around the thresholds was designed to minimize unobserved heterogeneity by sampling clusters with both beneficiary and non-beneficiary households. The research design exploits the sharp discontinuities at two regional eligibility thresholds to estimate local average treatment effects. Results suggest that the program did not affect utilization of health services but decreased mean out-of-pocket expenditures for some groups and reduced the risk of high inpatient expenditures. There are no systematic impacts on health behavior, management of chronic illnesses, and patient satisfaction.

Keywords: health insurance, service utilization, financial protection, Georgia, government targeting

JEL Classification: G22, I1

Suggested Citation

Bauhoff, Sebastian and Hotchkiss, David and Smith, Owen, The Impact of Medical Insurance for the Poor in Georgia: A Regression Discontinuity Approach (October 14, 2010). Health Economics, October 2010. Available at SSRN: https://ssrn.com/abstract=1790565

Sebastian Bauhoff (Contact Author)

Center for Global Development ( email )

2055 L Street NW
Washington, DC DC 20009
United States

HOME PAGE: http://scholar.harvard.edu/bauhoff/

David Hotchkiss

Tulane University - School of Public Health and Tropical Medicine ( email )

6823 St Charles Ave
New Orleans, LA 70118
United States
504-988-3289 (Phone)

Owen Smith

affiliation not provided to SSRN ( email )

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