Household out-of-pocket health spending, health insurance coverage, and children’s school attendance in the Philippines

The microeconomics of family posits that households value and promote the welfare of their members, but given limited resources, their investments in terms of time and money in their children’s health and education and expenditures on other consumption goods are necessarily jointly determined. In this paper, we develop and test a household allocation model that highlights the links between out-of-pocket health spending, health insurance, and schooling decisions. Applying the model on subsamples of households from the 2004 and 2007 Annual Poverty Indicators Survey, we find that insurance coverage with PhilHealth tends to increase the share of health in total expenditures, which in turn reduces the likelihood of school attendance. We also find that PhilHealth coverage has a positive, significant, and independent effect on the likelihood of school attendance. These suggest that the design of social health insurance and other social protection programs, including household-level antipoverty programs, must take into account the joint determination of health, education, and other household decisions to achieve their desired overall impact on household welfare.