Social health insurance in the Philippines: do the poor really benefit?
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Social health insurance in the Philippines: do the poor really benefit? Salaheddine El Omari 1 & Mahmoud Karasneh 1 # The Author(s) 2020
Abstract Developing countries have spent a tremendous amount of time and money on social health insurance programs to give the low-income population free access to health care services. Standard economic theory predicts that people use care services more frequently and regularly when they are free. In this paper, we show that providing free access to health services might not be enough to enhance the utilization of health care by indigents. Keywords Social health insurance . Healthcare access . Health care utilization . Impact
evaluation . Indigents . Philippines JEL classification I13 . I15 . O11 . O53
1 Introduction Social health insurance is one possible way of financing health care services. It aims to reduce health inequalities by offering low-income households free access to medical services. According to standard economic theory, social health insurance improves the use of medical care by reducing the cost of care for indigent patients (Trujillo et al. (2005)). This theory is confirmed in developed countries, as shown by Buchmueller et al. (2005); Hadley (2003), among others. However, in the context of developing countries, there is no consensus among economists that health insurance coverage improves the use of health care services by indigents. Some empirical studies have reported favorable and statistically significant effects of social health insurance on the use of health care by indigent members (Galarraga et al. (2010); Panpiemras et al. (2011); Wagstaff and Pradhan (2005), among others), while other studies do not show
* Salaheddine El Omari [email protected]
1
Department of Finance and Economics, Qatar University, Doha, Qatar
Journal of Economics and Finance
any significant impact (Bauhoff et al. (2011); King et al. (2009); Thornton et al. (2010); Wagstaff and Moreno-Serra (2009); among others). In recent years, there has been an increasing interest in social health insurance programs and high-quality impact evaluation (see, for example, Savedoff et al. (2006) and Simon and Barmeier (2010)). Giedion et al. (2013), in their review of research published in the past 15 years on the impact of health insurance programs in developing countries, indicate that approximately 40% of all reviewed studies resort to either multivariate analysis or simple mean comparisons. The empirical evidence based on these evaluation methods generally suggests a positive effect of participation in health insurance programs on the use of health care by low-income households (Makinen and Konaté (2005); Scheil-Adlung and Jütting (2006), among others). However, these methods might not be appropriate for identifying the causal effect of an insurance health program in the absence of randomization. Indeed, the group of participating members and that of non-participants are likely to be distinguished by characteristics that influence recourse to healthcare, such as age, education, income,
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