IDEAS home Printed from https://ideas.repec.org/p/not/notcre/20-04.html
   My bibliography  Save this paper

Heterogeneous effect of health insurance on financial risk: Evidence from two successive surveys in Ghana

Author

Listed:
  • Samuel Ampaw
  • Simon Appleton
  • Xuyan Lou

Abstract

This paper evaluates the heterogeneous effect of health insurance on out-of-pocket healthcare expenditure (OOPHE), using merged data from the Ghana Living Standards Survey and Ghana Health Service reports. It applies conditional-mixed process and censored quantile instrumental variable estimators to tackle censoring and endogeneity. We instrument household insurance rate with community insurance rate (exclusive of the observed household) and control for community unobservables. The quantile regression allows the insurance effect to differ across the distribution of OOPHE. We further perform separate analyses by the types of OOPHE and selected covariates. The results show that insurance reduced OOPHE and the incidence of catastrophic OOPHE in 2013, but not in 2017. Besides, households in the higher expenditure quantiles benefitted more from coverage than those in the median and lower quantiles did in 2013. Also, the insurance benefits accrued exclusively to the wealthiest households, households with older heads, and users of outpatient services in 2013. Lastly, the 2013 survey reveals that families with female heads and those whose heads had primary education benefitted more from health insurance than their counterparts in the other subgroups did. The paper concludes that same health insurance can have varied financial risk implications at different periods, across the distribution of OOPHE, and among various household categories.

Suggested Citation

  • Samuel Ampaw & Simon Appleton & Xuyan Lou, 2020. "Heterogeneous effect of health insurance on financial risk: Evidence from two successive surveys in Ghana," Discussion Papers 2020-04, University of Nottingham, CREDIT.
    • Handle: RePEc:not:notcre:20/04
    as

    Download full text from publisher

    File URL: https://www.nottingham.ac.uk/credit/documents/papers/2020/20-04.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Dixon, Jenna & Luginaah, Isaac & Mkandawire, Paul, 2014. "The National Health Insurance Scheme in Ghana's Upper West Region: A gendered perspective of insurance acquisition in a resource-poor setting," Social Science & Medicine, Elsevier, vol. 122(C), pages 103-112.
    2. Barnes, Kayleigh & Mukherji, Arnab & Mullen, Patrick & Sood, Neeraj, 2017. "Financial risk protection from social health insurance," Journal of Health Economics, Elsevier, vol. 55(C), pages 14-29.
    3. Li, Xin & Zhang, Wei, 2013. "The impacts of health insurance on health care utilization among the older people in China," Social Science & Medicine, Elsevier, vol. 85(C), pages 59-65.
    4. Azam, Mehtabul, 2018. "Does Social Health Insurance Reduce Financial Burden? Panel Data Evidence from India," World Development, Elsevier, vol. 102(C), pages 1-17.
    5. Craig L. Garthwaite, 2012. "The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions," American Economic Journal: Economic Policy, American Economic Association, vol. 4(3), pages 190-215, August.
    6. Bucheli, José R. & Fontenla, Matías & Waddell, Benjamin James, 2019. "Return migration and violence," World Development, Elsevier, vol. 116(C), pages 113-124.
    7. Zhang, Anwen & Nikoloski, Zlatko & Mossialos, Elias, 2017. "Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly," Social Science & Medicine, Elsevier, vol. 190(C), pages 11-19.
    8. Liu, Hong & Zhao, Zhong, 2014. "Does health insurance matter? Evidence from China’s urban resident basic medical insurance," Journal of Comparative Economics, Elsevier, vol. 42(4), pages 1007-1020.
    9. Stephen Abrokwah & Christine Moser & Edward Norton, 2014. "The effect of social health insurance on prenatal care: the case of Ghana," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 385-406, December.
    10. Hayne E. Leland, 1968. "Saving and Uncertainty: The Precautionary Demand for Saving," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 82(3), pages 465-473.
    11. Dreze, Jacques H. & Modigliani, Franco, 1972. "Consumption decisions under uncertainty," Journal of Economic Theory, Elsevier, vol. 5(3), pages 308-335, December.
    12. AfDB AfDB, . "Annual Report 2012," Annual Report, African Development Bank, number 461.
    13. Council on Food Agricultural and Resource Economics, C-FARE, 2014. "2013 Annual Report," C-FARE Reports 260836, Council on Food, Agricultural, and Resource Economics (C-FARE).
    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. Chen, Yi & Shi, Julie & Zhuang, Castiel Chen, 2019. "Income-dependent impacts of health insurance on medical expenditures: Theory and evidence from China," China Economic Review, Elsevier, vol. 53(C), pages 290-310.
    2. Gollier, Christian, 2002. "Time Horizon and the Discount Rate," Journal of Economic Theory, Elsevier, vol. 107(2), pages 463-473, December.
    3. repec:hal:spmain:info:hdl:2441/4aorppjfgr8v2prdh6fmd1kaik is not listed on IDEAS
    4. Martin Flodén, 2006. "Labour Supply and Saving Under Uncertainty," Economic Journal, Royal Economic Society, vol. 116(513), pages 721-737, July.
    5. repec:dau:papers:123456789/11094 is not listed on IDEAS
    6. Kwame Adjei-Mantey & Charles Yuji Horioka, 2023. "Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis," Review of Economics of the Household, Springer, vol. 21(4), pages 1269-1288, December.
    7. Hubbard, R. Glenn & Skinner, Jonathan & Zeldes, Stephen P., 1994. "The importance of precautionary motives in explaining individual and aggregate saving," Carnegie-Rochester Conference Series on Public Policy, Elsevier, vol. 40(1), pages 59-125, June.
    8. Mark Huggett, 2004. "Precautionary Wealth Accumulation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 71(3), pages 769-781.
    9. Barsky, Robert B & Mankiw, N Gregory & Zeldes, Stephen P, 1986. "Ricardian Consumers with Keynesian Propensities," American Economic Review, American Economic Association, vol. 76(4), pages 676-691, September.
    10. Donatella Baiardi & Marco Magnani & Mario Menegatti, 2014. "Precautionary saving under many risks," Journal of Economics, Springer, vol. 113(3), pages 211-228, November.
    11. Guillermo Cruces, 2005. "Income Fluctuations, Poverty and Well-Being Over Time: Theory and Application to Argentina," Labor and Demography 0502007, University Library of Munich, Germany.
    12. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "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, Public Library of Science, vol. 14(8), pages 1-20, August.
    13. Drechsler, Martin & Watzold, Frank, 2007. "The optimal dynamic allocation of conservation funds under financial uncertainty," Ecological Economics, Elsevier, vol. 61(2-3), pages 255-266, March.
    14. Kit Pong Wong, 2005. "Tax asymmetry and futures hedging under liquidity constraints," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 271-281.
    15. Clemens, Christiane & Soretz, Susanne, 1999. "Konsequenzen des Zins- und Einkommensrisikos auf das wirtschaftliche Wachstum," Hannover Economic Papers (HEP) dp-221, Leibniz Universität Hannover, Wirtschaftswissenschaftliche Fakultät.
    16. Hauenschild, Nils & Stahlecker, Peter, 2001. "Precautionary saving and fuzzy information," Economics Letters, Elsevier, vol. 70(1), pages 107-114, January.
    17. Bertram C. I. Okpokwasili, Ph.D, 2015. "Income Inequality: Do Different Inequality Measures Show Different Impacts on Economic Growth, at the State Level? An Analysis of the State of New Jersey," International Journal of Business and Social Research, MIR Center for Socio-Economic Research, vol. 5(12), pages 40-55, December.
    18. Chou, Shin-Yi & Liu, Jin-Tan & Hammitt, James K., 2003. "National Health Insurance and precautionary saving: evidence from Taiwan," Journal of Public Economics, Elsevier, vol. 87(9-10), pages 1873-1894, September.
    19. Cary Deck & Harris Schlesinger, 2014. "Consistency of Higher Order Risk Preferences," Econometrica, Econometric Society, vol. 82, pages 1913-1943, September.
    20. Alba Lugilde & Roberto Bande & Dolores Riveiro, 2018. "Precautionary saving in Spain during the great recession: evidence from a panel of uncertainty indicators," Review of Economics of the Household, Springer, vol. 16(4), pages 1151-1179, December.
    21. Aj A Bostian & Christoph Heinzel, 2020. "Robustness of Inferences in Risk and Time Experiments to Lifecycle Asset Integration," Post-Print hal-03358620, HAL.
    22. Huggett, Mark & Ospina, Sandra, 2001. "Aggregate precautionary savings: when is the third derivative irrelevant?," Journal of Monetary Economics, Elsevier, vol. 48(2), pages 373-396, October.

    More about this item

    Keywords

    health insurance; financial risk protection; out-of-pocket healthcare expenditure; catastrophic healthcare expenditure; quantile regression; Ghana;
    All these keywords.

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:not:notcre:20/04. 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: Hilary Hughes (email available below). General contact details of provider: https://edirc.repec.org/data/cenotuk.html .

    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.