Essays on International Health Economics: The Role of Health Insurance in Health Care Financing in Low- and Middle-Income Countries

Björn Ekman

Essays on International Health Economics: The Role of Health Insurance in Health Care Financing in Low- and Middle-Income Countries

Socialepidemiologi

Forskningsoutput: Avhandling › Doktorsavhandling (sammanläggning)

Sammanfattning

Popular Abstract in Swedish
Denna avhandling i nationalekonomi består av fyra stycken självständiga akademiska arbeten. Syftet med avhandlingen är att studera vilken roll hälsoförsäkringar spelar för den privata finansieringen av hälso- och sjukvården i låg- och mellaninkomstländer. Arbetena studerar både effektivitets- och fördelningsfrågor med hjälp av olika typer av metoder. De enskilda arbetena sammanfattas enligt följande:

Artikel I: Community-based health insurance in low-income countries: a systematic review of the evidence. Artikeln är publiserad i Health Policy and Planning i September 2004. Detta arbete består av en systematisk kunskapssammanställning av den tillgängliga litteraturen om effekterna av lokala hälsoförsäkringar i låginkomstländer. Särskilt studeras huruvida sådana system genererar ytterligare resurser till sektorn och om de ger ett effektivt finansiellt skydd för befolkningen i området. Resultatet visar att det finns starkt begränsad evidens för att så är fallet.

Artikel II: Catastrophic Health Payments and Health Insurance in Zambia: The Problem to the Answer?. Denna studie är en kvantitativ analys av huruvida individer i Zambia med tillgång till försäkring i mindre utsträckning än andra råkar ut för betalningar som överstiger en viss andel av deras samlade tillgångar vid händelse av sjukdomskrävande vård. Analysen visar, tvärtemot vad som initialt antas, att dessa patienter i högre utsträckning än andra drar på sig sådana sjukvårdskostnader. Vidare analys visar att resultatet kan bero på att dessa personer erhåller mer och dyrare vård än andra vilket gör att totalkostnaderna blir högre.

Artikel III: Multiple Health Insurance Availability, Health Care Utilization, and Expenditures: Evidence from Jordan. Denna studie använder hushållsdata från Jordanien för att med ekonometriska metoder studera huruvida tillgång till olika typer av hälsoföräkringsprogram leder till olika effekter på vårdutnyttjande och betalningar. Studien visar att olika försäkringsprogram har olika effekter på sannolikheten för att söka vård vid händelse av sjukdom och på intensiteten i vårdutnyttjandet, dvs. antal besök per sjukdomsepisod. Försäkringar spelar en mindre roll vad gäller betalningar, men även där finns skillnader mellan de olika programmen.

Artikel IV: A Note on Insurance Premium, Price Differentiation, and Moral Hazard. En tidigare version av detta papper utgjorde en del av licentiat avhandlingen. Studien är en teoretisk analys av effekterna av att försäkringspremium sätts i enlighet med försäkringstagarnas betalningsförmåga i motsatts till deras riskprofil. Resultatet av analysen visar att detta kan medföra ineffektivitet i betydelse att individernas förväntade marginalnyttor skiljer sig från varandra i händelse av sjukdom jämfört med att inte bli sjuk. Detta är ett marknadmisslyckande då syftet med försäkringen är just att dessa inte skiljer sig åt vid de två möjliga utfallen.

Originalspråk	engelska
Kvalifikation	Doktor
Tilldelande institution	Socialepidemiologi
Handledare	Lindgren, Björn, handledare
Tilldelningsdatum	2005 apr. 14
Förlag	Department of Economics, Lund University
Status	Published - 2005

Bibliografisk information

Defence details

Date: 2005-04-14
Time: 10:15
Place: Ekonomihögskolan, EC3:211

External reviewer(s)

Name: Mills, Anne
Title: Professor of Health Economics
Affiliation: London School of Hygiene and Tropical Medicine

---

Ämnesklassifikation (UKÄ)

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AB - The thesis consists of an introductory chapter and four independent research papers, summarized as follows. The introductory chapter discusses the role of economics in international health and the policy contributions of each of the particular papers. In addition, the data and the methods that have been used are discussed. Paper I, entitled Community-based health insurance in low-income countries: a systematic review of the evidence, assesses the evidence base for the extent to which community-based health insurance schemes in low-income countries mobilize resources and provide effective protection. Findings suggest that the evidence base is weak and that these schemes raise little resource and provide only moderate protection. Paper II, Catastrophic Health Payments and Health Insurance in Zambia: The Problem to the Answer, assesses the extent to which health care prepayment in Zambia provide protection against the catastrophic effects of health payments compared with paying for care out-of-pocket. The results indicate that prepayment does not provide such protection and that prepayment may even induce catastrophic effects due to its effect on the demand for care. The third paper, Multiple Health Insurance Availability, Health Care Utilization, and Expenditures: Evidence from Jordan, looks at various health insurance programs in Jordan. The analysis suggests that the effect of insurance on utilization and expenditures differ significantly across the various insurance types. Also, the effect of the programs differs across income groups. The final paper, A Note on Insurance Premiums, Price Differentiation, and Moral Hazard, is a theoretical note on insurance premium setting and moral hazard. It is shown that allowing insurance premiums to reflect insurers? ability to pay rather than marginal costs and risks will lead to market inefficiencies. The model and its findings have policy implications in, for example, poor settings where an insurer lets premiums differ so as to not exclude the poorest sections of the population.

KW - Low- and middle-income country

KW - Health insurance

KW - Health financing

KW - Samhällsvetenskaper

KW - Social sciences

KW - Econometric analysis

KW - Equity

M3 - Doctoral Thesis (compilation)

PB - Department of Economics, Lund University

ER -

Essays on International Health Economics: The Role of Health Insurance in Health Care Financing in Low- and Middle-Income Countries

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