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The impact of publicly-financed health insurance on the use of health services and on equity: A case study of Ecuador.

机译：公共财政医疗保险对医疗服务使用和公平的影响：厄瓜多尔的案例研究。

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摘要

This dissertation develops and uses methodologies to: (1) evaluate the impact of publicly-financed health insurance programs on the use of health care; (2) measure equity in the distribution of health services; and (3) measure the impact of insurance programs on equity. The dissertation tests for selection bias resulting from individuals' choice to be insured, as well as bias from the potential endogeneity of health status and insurance eligibility in the context of the demand for health services. The bivariate probit model is the principal estimation technique used.;The setting for the study is the country of Ecuador, where there are two publicly-financed health insurance programs. The General Health Insurance (GHI) program primarily benefits workers in the formal sector of the economy, while the Seguro Campesino Social (SSC) program is directed at farming populations in rural areas. The principal data source is the 1995 Ecuador Living Standards Measurement Survey.;A theoretical microeconomic model is developed to estimate the effect of insurance on the use of health services. This model is adapted as the dissertation proposes and tests for appropriate identifying variables, interaction terms, and non-linear terms. The GHI program is found to have a strongly positive effect on the use of acute health care, but no significant effect on the use of non-acute care. The SSC program has small, but still positive and significant, effects on the use of all types of health care. The impact of the GHI program is strongly influenced by selection in and out of the program.;The GHI program has a negative impact on equity in the distribution of health services. The SSC program improves equity in the distribution of non-acute health care, but does not have a substantial impact on equity in the distribution of acute care. The benefits of the GHI program, measured as the marginal impact of the program on the use of health care, have a strongly regressive distribution. The SSC program benefits have a progressive distribution.
机译：本文研究并运用了以下方法：（1）评估公共财政医疗保险计划对医疗保健的影响； （2）衡量卫生服务分配的公平性； （3）衡量保险计划对股权的影响。本文针对个人对被保险人的选择产生的选择偏见以及在健康服务需求的背景下健康状况和保险资格的潜在内生性产生的偏见进行测试。二元概率模型是使用的主要估计方法。该研究的背景是厄瓜多尔，该国有两个公共资助的健康保险计划。普通健康保险（GHI）计划主要使正规经济部门的工人受益，而Seguro Campesino社会（SSC）计划则针对农村地区的农业人口。主要数据来源是1995年厄瓜多尔生活水平测量调查。建立了理论上的微观经济模型来估计保险对医疗服务使用的影响。该模型适用于论文的建议和测试，用于适当的识别变量，交互项和非线性项。已发现GHI计划对急性医疗保健的使用产生了强烈的积极影响，但对非急性医疗保健的使用没有显着影响。 SSC计划对所有类型的医疗保健的使用都产生很小的影响，但仍然是积极而重要的。 GHI计划的影响在很大程度上取决于计划的进出。; GHI计划对医疗服务分配的公平性具有负面影响。 SSC计划提高了非急性医疗保健分配的公平性，但对急性医疗保健分配的公平性没有实质性影响。 GHI计划的收益（以该计划对医疗保健使用的边际影响衡量）具有很强的回归分布。 SSC计划的利益将逐步分配。

著录项

  • 作者

    Waters, Hugh Richard Dudley.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Health Sciences Health Care Management.;Sociology Public and Social Welfare.;Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 1999
  • 页码 315 p.
  • 总页数 315
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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