The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in
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The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria Emily Gustafsson-Wright1 · Gosia Popławska2 · Zlata Tanovi´c3,4 · Jacques van der Gaag1,5
Received: 15 August 2016 / Accepted: 4 October 2017 © Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract This paper analyzes the quantitative impact of an intervention that provides subsidized low-cost private health insurance together with health facility upgrades in Nigeria. The evaluation, which measures impact on healthcare utilization and spending, is based on a quasi-experimental design and utilizes three population-based household surveys over a 4-year period. After 4 years, the intervention increased healthcare use by 25.2 percentage
This research was made possible by funding from the Dutch Ministry of Foreign Affairs. This paper is also funded under the Grant “Policy Design and Evaluation Research in Developing Countries” Initial Training Network (PODER), which is funded under the Marie Curie Actions of the EU’s Seventh Framework Programme (Contract Number: 608109). The authors would like to thank the research teams in the Netherlands at AIID and AIGHD and in Nigeria at UITH for their tireless efforts and in particular Wendy Janssens, Berber Kramer and Bas van der Klaauw for their comments, Marijn van der List for her project management and Anne Duynhouwer and Marc Fabel for their research assistance. In addition, we are thankful to comments received at presentations given on previous versions of the paper at Abt Associates, Brookings Institution, DC Health Systems Board, Center for Global Development, the European Conference on Health Economics, and the University of Amsterdam. Finally, we would like to thank the anonymous reviewers for their excellent comments and suggestions to improve to this paper.
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Emily Gustafsson-Wright [email protected] Gosia Popławska [email protected] Zlata Tanovi´c [email protected] Jacques van der Gaag [email protected]
1
Brookings Institution, Washington, DC, USA
2
Department of Primary Health Care, Center for Health Service Economics and Organisation, University of Oxford, Oxford, UK
3
Vrije University (VU), Amsterdam, The Netherlands
4
Amsterdam Institute for International Development, Amsterdam, The Netherlands
5
Department of Economics and Business, University of Amsterdam, Amsterdam, The Netherlands
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points in the treatment area overall and by 17.7 percentage points among the insured. Utilization of modern healthcare facilities increased after 4 years by 20.4 percentage points in the treatment area and by 18.4 percentage points among the insured due to the intervention. After 2 years of program implementation, the intervention reduced healthcare spending by 51% compared with baseline, while after 4 years, spending resumed to pre-intervention levels. Keywords Health insurance · Financial risk · Nigeria · Impact evaluation JEL Classification
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