Impact of Health Insurance on Use and Equity: A Case Study of Ecuador. Abstract,Executive Summary and Final Report of Dissertation

摘要

This study develops and uses methodologies to: (1) evaluate the impact ofpublicly-financed health insurance programs on the use of health care; (2) measure equity in the distribition of health services; and (3) measure the impact of insurance programs on equity. The study tests for selection bias resulting from individuals' choice to be insured, as well as bias from the potential endogeneity of health status and insurance eligibility in the contest bias resulting from individuals' choice to be insured, as well as bias from the potential endogeneity of health status and insurance eligibility in the contest of the demand for health services. The bivariate probit model is the principal estimation technique used. The setting for the study is the country of Ecudador. The General Health Insurance (GHI) program, which primarily benefits workers in the formal sector of the economy, is found to have a strongly positive effect on the use of curative health care, but no significant effect on the use of preventive care. The Seguro Campesino Social (SSC) program, directed at farming populatioins, has small, but still positive and significant, effects on the use of all types of health care. The benefits of the GHI program have a strongly regressive distribution, while the SSC program benefits have a progressive. The benefits of the GHI program have a strongly regressive distribution, while the SSC program benefits have a progressive distribution.