IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v19y2010i2p189-208.html
   My bibliography  Save this article

Estimating health insurance impacts under unobserved heterogeneity: the case of Vietnam's health care fund for the poor

Author

Listed:
  • Adam Wagstaff

Abstract

Vietnam's health care fund for the poor (HCFP) uses government revenues to finance health care for the poor, ethnic minorities living in selected mountainous provinces, and all households living in communes officially designated as highly disadvantaged. As of 2006, the program, which started in 2003, covered around 60% of those eligible. Those who were covered (about 20% of the population) were disproportionately poor, and around 80% of those covered were eligible. Estimates of the program's impact were obtained using a method that takes into account unobserved heterogeneity – including unobserved idiosyncratic returns – but requires minimal assumptions. The downside is that it provides an estimate only of the program's impact on those covered by it; it cannot therefore answer the question of how those currently uncovered will fare when they are eventually covered. The results suggest that HCFP has had no impact on use of services, but has substantially reduced out‐of‐pocket spending. Copyright © 2009 John Wiley & Sons, Ltd.

Suggested Citation

  • Adam Wagstaff, 2010. "Estimating health insurance impacts under unobserved heterogeneity: the case of Vietnam's health care fund for the poor," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 189-208, February.
  • Handle: RePEc:wly:hlthec:v:19:y:2010:i:2:p:189-208
    DOI: 10.1002/hec.1466
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.1466
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.1466?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. James J. Heckman & Vytlacil, Edward J., 2007. "Econometric Evaluation of Social Programs, Part II: Using the Marginal Treatment Effect to Organize Alternative Econometric Estimators to Evaluate Social Programs, and to Forecast their Effects in New," Handbook of Econometrics, in: J.J. Heckman & E.E. Leamer (ed.), Handbook of Econometrics, edition 1, volume 6, chapter 71, Elsevier.
    2. Antonio Trujillo & Jorge Portillo & John Vernon, 2005. "The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching," International Journal of Health Economics and Management, Springer, vol. 5(3), pages 211-239, September.
    3. Vella, Francis & Verbeek, Marno, 1999. "Estimating and Interpreting Models with Endogenous Treatment Effects," Journal of Business & Economic Statistics, American Statistical Association, vol. 17(4), pages 473-478, October.
    4. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    5. Partha Deb & Chenghui Li & Pravin K. Trivedi & David M. Zimmer, 2006. "The effect of managed care on use of health care services: results from two contemporaneous household surveys," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 743-760, July.
    6. Jiwei Lou & Shuilin Wang, 2008. "Public Finance in China : Reform and Growth for a Harmonious Society," World Bank Publications - Books, The World Bank Group, number 6360.
    7. James Heckman & Salvador Navarro-Lozano, 2004. "Using Matching, Instrumental Variables, and Control Functions to Estimate Economic Choice Models," The Review of Economics and Statistics, MIT Press, vol. 86(1), pages 30-57, February.
    8. Ravallion, Martin, 2008. "Evaluating Anti-Poverty Programs," Handbook of Development Economics, in: T. Paul Schultz & John A. Strauss (ed.), Handbook of Development Economics, edition 1, volume 4, chapter 59, pages 3787-3846, Elsevier.
    9. Richard Blundell & Lorraine Dearden & Barbara Sianesi, 2003. "Evaluating the impact of education on earnings in the UK: Models, methods and results from the NCDS," IFS Working Papers W03/20, Institute for Fiscal Studies.
    10. Martin Ravallion & Emanuela Galasso & Teodoro Lazo & Ernesto Philipp, 2005. "What Can Ex-Participants Reveal about a Program’s Impact?," Journal of Human Resources, University of Wisconsin Press, vol. 40(1).
    11. Anirban Basu & James J. Heckman & Salvador Navarro-Lozano & Sergio Urzua, 2007. "Use of instrumental variables in the presence of heterogeneity and self-selection: An application in breast cancer patients," Health, Econometrics and Data Group (HEDG) Working Papers 07/07, HEDG, c/o Department of Economics, University of York.
    12. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    13. Brian Bell & Richard Blundell & John Reenen, 1999. "Getting the Unemployed Back to Work: The Role of Targeted Wage Subsidies," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 6(3), pages 339-360, August.
    14. Ardeshir Sepehri & Sisira Sarma & Wayne Simpson, 2006. "Does non‐profit health insurance reduce financial burden? Evidence from the Vietnam living standards survey panel," Health Economics, John Wiley & Sons, Ltd., vol. 15(6), pages 603-616, June.
    15. James J. Heckman & Vytlacil, Edward J., 2007. "Econometric Evaluation of Social Programs, Part I: Causal Models, Structural Models and Econometric Policy Evaluation," Handbook of Econometrics, in: J.J. Heckman & E.E. Leamer (ed.), Handbook of Econometrics, edition 1, volume 6, chapter 70, Elsevier.
    16. Cameron,A. Colin & Trivedi,Pravin K., 2005. "Microeconometrics," Cambridge Books, Cambridge University Press, number 9780521848053, September.
    17. Anirban Basu & James J. Heckman & Salvador Navarro-Lozano & Sergio Urzua, 2007. "Use of instrumental variables in the presence of heterogeneity and self-selection: an application to treatments of breast cancer patients," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1133-1157.
    18. Robert Moffitt, 1991. "Program Evaluation With Nonexperimental Data," Evaluation Review, , vol. 15(3), pages 291-314, June.
    19. Richard Blundell & Lorraine Dearden & Barbara Sianesi, 2005. "Evaluating the effect of education on earnings: models, methods and results from the National Child Development Survey," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 168(3), pages 473-512, July.
    20. Hugh R. Waters, 1999. "Measuring the impact of health insurance with a correction for selection bias-a case study of Ecuador," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 473-483.
    21. Jowett, M. & Contoyannis, P. & Vinh, N. D., 2003. "The impact of public voluntary health insurance on private health expenditures in Vietnam," Social Science & Medicine, Elsevier, vol. 56(2), pages 333-342, January.
    22. Nyman, John A., 1999. "The economics of moral hazard revisited," Journal of Health Economics, Elsevier, vol. 18(6), pages 811-824, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ali, Shehzad & Cookson, Richard & Dusheiko, Mark, 2017. "Addressing care-seeking as well as insurance-seeking selection biases in estimating the impact of health insurance on out-of-pocket expenditure," Social Science & Medicine, Elsevier, vol. 177(C), pages 127-140.
    2. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    3. Sarah Alkenbrack & Magnus Lindelow, 2015. "The Impact of Community‐Based Health Insurance on Utilization and Out‐of‐Pocket Expenditures in Lao People's Democratic Republic," Health Economics, John Wiley & Sons, Ltd., vol. 24(4), pages 379-399, April.
    4. Andrew M. Jones, 2007. "Identification of treatment effects in Health Economics," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1127-1131.
    5. Duvendack, Maren & Palmer-Jones, Richard, 2011. "The microfinance of reproduction and the reproduction of microfinance: understanding the connections between microfinance, empowerment, contraception and fertility in Bangladesh in the 1990s," MPRA Paper 32384, University Library of Munich, Germany.
    6. Black, Dan A. & Joo, Joonhwi & LaLonde, Robert & Smith, Jeffrey A. & Taylor, Evan J., 2022. "Simple Tests for Selection: Learning More from Instrumental Variables," Labour Economics, Elsevier, vol. 79(C).
    7. Andrés Ramírez Hassan & Johnatan Cardona Jimenez & Ramiro Cadavid Montoya, 2011. "The impact of subsidized health insurance on the poor in Colombia: Evaluating the case of Medellin," Documentos de Trabajo de Valor Público 10602, Universidad EAFIT.
    8. Arnab Acharya & Sukumar Vellakkal & Fiona Taylor & Edoardo Masset & Ambika Satija & Margaret Burke & Shah Ebrahim, 2013. "The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review," The World Bank Research Observer, World Bank, vol. 28(2), pages 236-266, August.
    9. Lingguo Cheng & Hong Liu & Ye Zhang & Ke Shen & Yi Zeng, 2015. "The Impact of Health Insurance on Health Outcomes and Spending of the Elderly: Evidence from China's New Cooperative Medical Scheme," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 672-691, June.
    10. Wagstaff, Adam, 2007. "Health insurance for the poor : initial impacts of Vietnam's health care fund for the poor," Policy Research Working Paper Series 4134, The World Bank.
    11. Domenico Depalo, 2020. "Explaining the causal effect of adherence to medication on cholesterol through the marginal patient," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 110-126, October.
    12. Liu, Dan & Tsegai, Daniel W., 2011. "The New Cooperative Medical Scheme (NCMS) and its implications for access to health care and medical expenditure: Evidence from rural China," Discussion Papers 116746, University of Bonn, Center for Development Research (ZEF).
    13. Sheikh Aftaab Ul Maroof & Mohi-ud-Din Sangmi, 2021. "Assessing financial impact of a health intervention program and controlling spillover effects," DECISION: Official Journal of the Indian Institute of Management Calcutta, Springer;Indian Institute of Management Calcutta, vol. 48(1), pages 15-25, March.
    14. Hong Wang & Winnie Yip & Licheng Zhang & William C. Hsiao, 2009. "The impact of rural mutual health care on health status: evaluation of a social experiment in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 65-82, July.
    15. McBain, Florence, 2014. "Health insurance and health environment: India’s subsidized health insurance in a context of limited water and sanitation services," Working Papers 179200, University of Bonn, Center for Development Research (ZEF).
    16. Daniel Polsky & Anirban Basu, 2012. "Selection Bias in Observational Data," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 46, Edward Elgar Publishing.
    17. H. Evans & A. Basu, 2011. "Exploring comparative effect heterogeneity with instrumental variables: prehospital intubation and mortality," Health, Econometrics and Data Group (HEDG) Working Papers 11/26, HEDG, c/o Department of Economics, University of York.
    18. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    19. Cornelissen, Thomas & Dustmann, Christian & Raute, Anna & Schönberg, Uta, 2016. "From LATE to MTE: Alternative methods for the evaluation of policy interventions," Labour Economics, Elsevier, vol. 41(C), pages 47-60.
    20. Emily Gustafsson-Wright & Gosia Popławska & Zlata Tanović & Jacques Gaag, 2018. "The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 221-276, September.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:19:y:2010:i:2:p:189-208. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.