Dutta, Mousumi and Husain, Zakir (2012): Use of hospital services and socio-economic status in urban India: Does health insurance ensure equitable outcomes?
Download (405Kb) | Preview
In recent years universal health coverage has become an important issue in developing countries. Successful introduction of such a social security system requires knowledge of the relationship between socio-economic status and usage of health care services. This paper examines this relationship, and analyzes the impact of introducing health insurance into the model, using data for India, a major developing country with poor health outcomes. In contrast to similar works undertaken for developed countries, results of the instrumental variable model estimated reveals that the positive relation between usage of in-patient services and socio-economic status persists even in the presence of health insurance. This implies that insurance is unable to eliminate the inequities in accessing health care services stemming from disparities in socio-economic status. In fact, the presence of a double moral hazard and adverse selection leads to further attenuation of inequity in the health care market. The study is based on unit level data from the “Morbidity and Health Care Survey” undertaken by the National Sample Survey Organization (2005-06).
|Item Type:||MPRA Paper|
|Original Title:||Use of hospital services and socio-economic status in urban India: Does health insurance ensure equitable outcomes?|
|Keywords:||Hospitalization; Health insurance; Strategic independence; Simultaneous equation system; SES-health gradient; India|
|Subjects:||I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets
C - Mathematical and Quantitative Methods > C3 - Multiple or Simultaneous Equation Models; Multiple Variables > C34 - Truncated and Censored Models; Switching Regression Models
|Depositing User:||Zakir Husain|
|Date Deposited:||13. Jul 2012 14:45|
|Last Modified:||19. Feb 2013 00:09|
Aggarwal A. 2010. Impact evaluation of India's ‘Yeshasvini’ community-based health insurance programme. Health Economics 19(S1): 5–35.
Arkes J. 2004. Does Schooling Improve Adult Health? Rand Corporation Working Paper.
Becker GS. 1964. Human Capital: A Theoretical and Empirical Analysis, with Special Reference to Education. Columbia University Press: New York.
Behrman JR, Wolfe BL. 1982. Determinants of child mortality, health and nutrition in a developing country. Journal of Development Economics 11(2): 105-128.
Van den Berg AE, Maas J, Verheij RA, Groenewegen PP. 2010. Green space as a buffer between stressful life events and health. Social Science and Medicine 70(8): 1203-1210.
Bhattacharyya S, Lafontaine F. 1995. Double-Sided Moral Hazard and the Nature of Share Contracts. Rand Journal of Economics 26: 761-781.
Berman P, Ahuja R, Bhandari L. 2010. The Impoverishing Effect of Healthcare Payments in India: New Methodology and Findings. Economic & Political Weekly 45: 65-51.
Blomqvist A. 1991. The Doctor as Double Agent: Information Asymmetry, Health Insurance, and Medical Care. Journal of Health Economics 10: 411-432.
Cohen M, Sinding MA. 1996. Changing Concepts of Women’s Health-Advocating for change. http://www.hc-sc.gc.ca/canusa/papers/canada/english/advocate/htm.
Corvalán CF, Kjellström T, Smith KR. 1999. Health, Environment and Sustainable Development -Identifying Links and Indicators to Promote Action. Epidemiology 10: 656-660.
Cooper R, Ross TW, 1985. Product Warranties and Double Moral Hazard. Rand Journal of Economics 16: 103-113.
Cutler DM, Zeckhauser RJ. 2000. The Anatomy of Health Insurance. In Handbook of Health Economics: Volume 1A, Culyer AJ, Newhouse JP (eds.). Elsevier: Amsterdam, 563-643. Culyer AJ , Wagstaff A.1993. Equity and equality in health and health care. Journal of health economics 12: 431-457.
Demski JS, Sappington DEM. 1991. Resolving Double Moral Hazard Problems with Buyout Agreements. Rand Journal of Economics 22: 232-240.
Economou A, Nikolaou A, Theodossiou I. 2008. Socioeconomic status and health-care utilization: a study of the effects of low income, unemployment and hours of work on the demand for health care in the European Union. Health Service Management Research 21(1): 40-59.
Ellis RP, McGuire TG. 1990. Optimal Payment Systems for Health Services. Journal of Health Economics 9: 375-396.
Feldstein M. 1977. Quality Change and the Demand for Hospital Care. Econometrica 45(7): 1681-1702.
Folland S, Goodman A, Stano M. 2006. Economics of Health and Health Care. Prentice Hall: New York.
Fuchs, V.R., and M. Kramer (1972). Determinants of Expenditure for Physicians' Services in the United States, 1948-68. National Bureau of Economic Research: New York.
Gaynor M. 1994. Issues in the Industrial Organization of the Market for Physician Services. Journal of Economics and Management Strategy 3: 211-255.
Ghosh S. 2011. Catastrophic Payments and Impoverishment Due to Out-of-Pocket Health Spending. Economic & Political Weekly XLVI(47): 63-70.
Government of India. 2002. National Health Profile: 2001. Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare: New Delhi.
Government of India. 2004. Morbidity, Health Care and the Condition of the Aged, Report No. 507. National Sample Survey Organisation: New Delhi.
Grimmard F, Parent D, 2007. Education and smoking: Were Vietnam Draft avoiders Also More likely to Avoid Smoking? Journal of Health Economics 26: 896-926.
Grossman M. 1972a. The Demand for Health: A Theoretical and Empirical Investigation. Columbia University Press of the National Bureau of Economic Research: New York.
Grossman M. 1972b. On the Concept of Health Capital and the Demand for Health. Journal of Political Economy 80(2): 223-255.
Grossman M. 1975. The correlation between health and education. In Household Production and Consumption, Terleckyj N (ed.). Columbia University Press: New York, 147-211.
Grossman M. 2000. The Human Capital Model. In Handbook of Health Economics, Volume 1A, Culyer A, Newhouse J (eds.), Elsevier: Amsterdam, 347-408.
Grossman M, Kaestner R. 1997. Effects of Education on Health. In The Social Benefits of Education. Behrman JR, Stacey N. (eds.), University of Michigan Press: Ann Arbour, 69-123.
Guralnik Jack M, Land Kenneth C, Blazer Dan, Fillenbaum Gerda G, Branch Laurence G. 1993. Educational Status and Active Life Expectancy among Older Blacks and Whites. New England Journal of Medicine 329(2): 110-116.
Hausmann-Muela, S, Ribera JM, Nyamongo I. 2003. Health- seeking behaviour and the health system response. Disease Control Priorities Project Working Paper 14/03.
Henderson J. 2002. Demand for Health and Medical Care. Cengage Learning: South Western Thompson Learning.
Hurley J. 2000. An overview of the normative economics of the health sector. Handbook of Health Economics. In Handbook of Health Economics Vol. 1, Culyer AJ, Newhouse JP (ed.). North Holland: Elsevier, 55-118.
Jowett M, Deolalikar A, Martinsson P. 2004. Health insurance and treatment seeking behaviour: evidence from a low-income country. Health Economics 13: 845–857.
Kakwani N, Wagstaff A, van Doorslaer E. 1997. Socioeconomic inequalities in health: Measurement, computation, and statisical inference. Journal of Econometrics 77: 87-103.
Karn Sunil Kumar, Shikura Shigeo, Harada Hideki. 2003. Living Environment and Health of Urban Poor-A Study in Mumbai. Economic and Political Weekly 38(34): 3575-3577.
Kim SK, Wang S. 1998. Linear Contracts and the Double Moral-Hazard. Journal of Economic Theory 82: 342-378.
Kuate-efo B. 1997. Effects of socio-economic disadvantage and women’s status on women’s health in Cameroon. Social Science and Medicine 44(7): 1023-1042.
Maas J, van Dillen SM, Verheij RA, Groenewegen PP. (2009): Social contacts as a possible mechanism behind the relation between green space and health. Social Science and Medicine 15(2): 586-595.
Ma CT, McGuire T. 1997. Optimal health insurance and provider payment. The American Economic Review 87(4): 685-704.
Mincer J. 1974. Schooling, Experience and Earnings. National Bureau of Economic Research: New York.
Mukherjee S, Haadad S, Narayana D. 2011. Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, South India. International Journal for Equity in Health 10(1). Available from http://www.equityhealthj.com/content/10/1/1.
Ngugi R. 1999. Health seeking behaviour in the reform process for rural households: The case of Mwea division, Kirinyaga district, Kenya. African Economic Research Consortium, Research Paper 95/99 Nairobi.
Oliver A, Mossialos E. 2008. Equity of access of health care: Outlining the foundations for action. Journal of Epidemiology and Community Health 58: 655-658.
Oreopoulos P. 2006. Estimating Average and Local Average Treatment Effects of Education When Compulsory Schooling Laws Really Matter. American Economic Review 96: 152-75.
Pal S. 1999. An Analysis of Childhood Malnutrition in Rural India: Role of Gender, Income and Other Household Characteristics. World Development Report 27(7): 1151-1171.
Pappas G, Queen S, Hadden W, Fisher G, 1993. The Increasing Disparity in Mortality between Socioeconomic Groups in the United States, 1960 and1986. New England Journal of Medicine 329(2): 103-109.
Pauly MV. 1968. The Economics of Moral Hazard: Comment. American Economic Review 58(3): 531-537. Reinhardt U. 1985. The Theory of Physician-Induced Demand: Reflections after a Decade. Journal of Health Economics 2(4): 190-193.
Richardson E, Roberts B, Sava V, Menon R, McKee M. 2012. Health insurance coverage and health care access in Moldova. Health Policy and Planning 27(3): 204-212.
Routh J, Fiamma A, Lane T, Fritz K. 2004. Mobile HIV Testing Program Removes Barriers to Testing in Sub-Saharan Africa. Paper read at XV International AIDS Conference, at Bangkok, Thailand.
Selden TM. 1990. A Model of Capitation. Journal of Health Economics 9: 397-409.
Selvaraj S, KAran AK. (2012) Why Publicly-Financed Health Insurance Schemes Are Ineffective in Providing Financial Risk Protection. Economic & Political Weekly XLVII(11): 60-68.
Somers AR. 1986. The Changing Demand for Health Services: A Historical Perspective and Some Thoughts for the Future. Inquiry 23(1): 395-402.
Shahrawat R, Rao KD. 2012. Insured yet vulnerable: out-of-pocket payments and India’s poor. Health Policy and Planning 27(3): 213-221.
van Doorslaer EKA, Wagstaff A, Rutten FFH. (eds.) 1993. Equity in the finance and delivery of health care: An international perspective. Oxford University Press, Oxford.
van Doorslaer E. O’Donnell O, Rennan - Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbiants D, Herrin AN, Haq MN, Ibragimava S, Karan A, Wan Ng C, Pande BR, Racelis R, Tao S, Tin K, Tisayaticorn K, Trisnantoro L, Vasavid C, Zaho Y. 2006. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 368(9544): 1357-64.
Wagstaff A. 1986. The Demand for Health: Some New Empirical Evidence. Journal of Health Economics 5: 195-233.
Wagstaff A, van Doorslaer E. 2003. Catastrophe and Impoverishment in Paying for Health Care: with Applications to Vietnam 1993-98. Health Economics 12: 921-34.
Würthwein R, Gbangou A, Kouyaté B, Mugisha F, Yé Y, Becher H, Schmidt CM, Sauerborn R. (2001) The Nouna Health District Household Survey: Design and Implementation. Uni-Heidelberg Discussion Paper 3/2001
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL. 2003. Household Catastrophic Health Expenditure: A Multi country Analysis. The Lancet 362(9378): 111-17.
Zweifel P, Freidrich B, Kifmann M. 2009. Health Economics. Springer: New York.