TY - JOUR
T1 - Health insurance ownership and its impact on healthcare utilization
T2 - evidence from an emerging market economy with a free healthcare policy
AU - Sisira Kumara, Ajantha
AU - Samaratunge, Ramanie
PY - 2019/12/30
Y1 - 2019/12/30
N2 - Purpose: The purpose of this paper is to explore the determinants of health insurance ownership of individuals in the Sri Lankan labor force and to examine how insurance ownership impacts healthcare utilization. Design/methodology/approach: The authors first used logit model to explore determinants of health insurance ownership. The authors then employed propensity score matching method to estimate impact of insurance ownership on healthcare utilization. Data were obtained from national survey of self-reported health in Sri Lanka – 2014 (n=59,276). National survey of self-reported health in Sri Lanka – 2014 was conducted by the Department of Census and Statistics from January to December 2014. Findings: Results showed that individuals with higher educational attainments, headed by literate-heads, based in urban sector, employed in formal sector, and with health adversities and higher degree of risk propensity are more inclined to have a health cover. Health insurance ownership reduces the likelihood of utilizing public facilities while increasing the likelihood of utilizing private facilities for non-communicable diseases (NCDs) and acute illnesses. Welfare consequences of expanding insurance ownership are doubtful due to oligopolistic private healthcare market and adverse selection issue faced by insurers in Sri Lanka. Originality/value: This is the first study examining health insurance–healthcare utilization nexus based on Sri Lanka-wide microdata. Also, the study applies bias-corrected matching methods to establish causal links between two constructs. Without being so generalized, healthcare utilization is examined in terms of NCD care and Acute illnesses care, which improves robustness of results and leads to evidence-based healthcare policies. Peer review: The peer review history for this paper is available at: https//publons.com/publon/10.1108/IJSE-05-2019-0333.
AB - Purpose: The purpose of this paper is to explore the determinants of health insurance ownership of individuals in the Sri Lankan labor force and to examine how insurance ownership impacts healthcare utilization. Design/methodology/approach: The authors first used logit model to explore determinants of health insurance ownership. The authors then employed propensity score matching method to estimate impact of insurance ownership on healthcare utilization. Data were obtained from national survey of self-reported health in Sri Lanka – 2014 (n=59,276). National survey of self-reported health in Sri Lanka – 2014 was conducted by the Department of Census and Statistics from January to December 2014. Findings: Results showed that individuals with higher educational attainments, headed by literate-heads, based in urban sector, employed in formal sector, and with health adversities and higher degree of risk propensity are more inclined to have a health cover. Health insurance ownership reduces the likelihood of utilizing public facilities while increasing the likelihood of utilizing private facilities for non-communicable diseases (NCDs) and acute illnesses. Welfare consequences of expanding insurance ownership are doubtful due to oligopolistic private healthcare market and adverse selection issue faced by insurers in Sri Lanka. Originality/value: This is the first study examining health insurance–healthcare utilization nexus based on Sri Lanka-wide microdata. Also, the study applies bias-corrected matching methods to establish causal links between two constructs. Without being so generalized, healthcare utilization is examined in terms of NCD care and Acute illnesses care, which improves robustness of results and leads to evidence-based healthcare policies. Peer review: The peer review history for this paper is available at: https//publons.com/publon/10.1108/IJSE-05-2019-0333.
KW - Acute illnesses
KW - Health insurance
KW - Healthcare utilization
KW - NCDs
KW - Sri Lanka
UR - http://www.scopus.com/inward/record.url?scp=85077632346&partnerID=8YFLogxK
U2 - 10.1108/IJSE-05-2019-0333
DO - 10.1108/IJSE-05-2019-0333
M3 - Article
AN - SCOPUS:85077632346
VL - 47
SP - 244
EP - 267
JO - International Journal of Social Economics
JF - International Journal of Social Economics
SN - 0306-8293
IS - 2
ER -