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      Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor.

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          Abstract

          Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a "fuzzy" regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services - with measurable health gains.

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          Regression Discontinuity Designs in Economics

          David S M Lee, Thomas Lemieux (2010)
          Article 0 comments Cited 316 times – based on 0 reviews     Review now
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            Household catastrophic health expenditure: a multicountry analysis.

            Christopher Murray, Lewis Evans, J Klavus … (2003)
            Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses. We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met. The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance. People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.
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              Regression discontinuity designs: A guide to practice

              Guido Imbens, Thomas Lemieux (2008)
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Am Econ J Appl Econ
                Title: American economic journal. Applied economics
                Publisher: American Economic Association
                ISSN: 1945-7782
                ISSN (Print): 1945-7790
                Publication date (Electronic): Oct 2013
                Volume: 5
                Issue: 4
                Affiliations
                [1 ] Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019, USA, and National Bureau of Economic Research.
                [2 ] Inter-American Development Bank, 1300 New York Avenue, N.W., Washington, DC 20577, USA.
                [3 ] Department of Economics, University College London, Gordon street, London, WC1E 6BT, UK, and Institute for Fiscal Studies (IFS).
                Article
                Mid ID: NIHMS521053
                DOI: 10.1257/app.5.4.61
                PMC ID: 4208673
                PubMed ID: 25346799
                SO-VID: 77cc5bfc-2d64-4b0a-a730-f08a485d3e61
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