The impact of medical insurance for the poor in Georgia: a regression discontinuity approach
Article first published online: 14 OCT 2010
Copyright © 2010 John Wiley & Sons, Ltd.
Volume 20, Issue 11, pages 1362–1378, November 2011
How to Cite
Bauhoff, S., Hotchkiss, D. R. and Smith, O. (2011), The impact of medical insurance for the poor in Georgia: a regression discontinuity approach. Health Econ., 20: 1362–1378. doi: 10.1002/hec.1673
- Issue published online: 5 OCT 2011
- Article first published online: 14 OCT 2010
- Manuscript Accepted: 24 AUG 2010
- Manuscript Revised: 27 JUL 2010
- Manuscript Received: 11 DEC 2009
- health insurance;
- service utilization;
- financial protection;
- government targeting
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. Copyright © 2010 John Wiley & Sons, Ltd.