hefpa paper digest i
DESCRIPTION
HEFPA Paper Digest I. Supon Limwattananon. WP2 WP1. Health shocks - Labor supply - Income (earned and unearned) - Medical spending Food consumption Non-food consumption. - Health insurance - Coping methods: - Saving - Gift - Borrowing/loan - Asset. - PowerPoint PPT PresentationTRANSCRIPT
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HEFPA Paper Digest I
Supon LimwattananonSupon Limwattananon
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WP
2
WP
1
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Health shocks
- Labor supply
- Income (earned and unearned) - Medical spending
Food consumption Non-food consumption
- Health insurance
- Coping methods:
- Saving - Gift - Borrowing/loan - Asset
- Social insurance/security
- Informal solidarity
Consumption insurance
Financial risks
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Paper 3
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Which kind of insurance can protect welfare loss?
• For common minor illnesses vs. for unanticipated major illnesses
• First-dollar coverage with low capped benefits vs. catastrophic insurance with patient cost-sharing
1
1 Townsend (1995); Kochar (1995) found families in LICs were able to insure illness shocks fairly well.
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Objective
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FindingsSection III:
Section IV:
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Panel data
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Fixed-effects model
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(1) ADLs vs. (2) Self-reported illness symptoms
Symptom lasting > 1 mo.Any symptom
1.
2.12.21.1
1.2
mean (SD)
%
%%mean (SD)
mean (SD)
hij
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Problems on self-reported illnesses
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Lij
3.
2.
1.1
1.2
Xij
Labor supply/wk
This has to be imputed for informal sectors
per wk
(C/n)ij
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hij
Xij
Lij (1.1)
2.1
2.2
1.
per wk
Section III
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hij 2.1 2.2 1.
Lij
1.1
1.2
2.
3.
per wk
Interpretation:
Moving from being able to perform all ADLs to being able to perform none would result in
- lowering hours of work by 30.9 hours per week (84% of baseline mean hours)
- 73.8% likelihood of becoming labor-force nonparticipant
- a reduction of earnings by Rp.20,170 (~ baseline mean earnings)
- an increase in medical spending of Rp.1,180
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Section III
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Section IV: Consumption insurance
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ln(C/n)ij
hij
Xij
2.1
2.2
1.
Moving from being able to perform all ADLs to being able to perform none would lower consumption by 19.5%
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Section IV
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Section V: The extent to which households are able to insure consumption
Biased est.: For each Rp. that income falls, consumption falls by only 3%
Unbiased est.: For each Rp. that income falls, consumption falls by 35%
Households are able to insure only 65% of the consumption with respect to income loss due to a loss in ADL
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Instrument Variable (IV)
Y = 1 + 1h + Z1 + 1
C = 2 + 2 + X2 + 2
^
YPredicted Y as an instrument
Step 1. Income
Step 2. Consumption
C = 0 + 0Y + X0 + 0
OLS method
Y is endogenous: some unobserved variables affect both Y and C.
Hence, Is biased (change in Y affecting change in C is spurious).
Consumption:
IV method
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Paper 4
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Sht-1
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Sht-1
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1.1
1.21.
2.
3.1
3.2
ln yht
1.
2.12.2
3.
Sht-1
Xht
e.g., gift, remittance, pension, compensation
e.g., wage/salary, agriculture, family business
esp., direct, nonmedical costs of care
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yht
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Rural
Urban
Effects on income per household
An urban household’s earned income
is more vulnerable to death shocks
than an rural household’s.
Statistically non-significant
Regression coefficient and (t-statistics)
Statistically non-significant
An increase in unearned income
offsets a decrease in earned income;
whereby other-than death shocks in
urban area are larger than in rural area.
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Urban
Rural
Effects on income per capita
Effect of a death on per capita income
Is statistically non-significant and is
less than on household income.
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Effects on medical expenditure (1)
Urban
Rural
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Effects on medical expenditure (2)
Insured
Uninsured
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Effects on food consumption
Rural
Urban
Households cannot smooth their food consumption in the face of some health shocks!
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Effects on non-food/non-medical consumption
Urban
Rural
The evidence is more mixed!
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Pr (y>0)
E[y|y>0](Housing)
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Health shocks
Year 2004-05(wave 1: N = 5,673)
Year 2005-06(wave 2: N = 5,495)
% Dead: Any HH members 0% 2.3%
% Ill: Any HH members 57.0% 53.8%
% Ill: HH head 37.8% 35.1%
% Ill: Other than head 19.1% 18.7%
% Ill: Working member 43.4% 40.7%
% Hospitalized: Any HH members 21.3% NA
% Hospitalized: HH head 10.3% NA
% Hospitalized: Other than head 11.0% NA
% Hospitalized: Working member 14.7% NA
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Economic consequencesYear 2005-06
(wave 2)Year 2006-07
(wave 3)
Mean Unearned income (Baht) 911 992
Mean Earned income (Baht) 4,357 4,664
Mean Total income (Baht) 5,269 5,656
% Catastrophic health exp. (>10% total exp.) 3.3% 3.3%
% Positive health exp. 57.3% 51.0%
Mean Health exp. (Baht), given positive 98 104
Mean Food expenditure (Baht) 1,173 1,260
Mean Nonfood/non-health exp. (Baht) 1,867 2,186
% Positive education exp. 56.2% 55.8%
Mean Education exp. (Baht), given positive 269 289
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Covariates for adjustment
Year 2006 Year 2007
% Urban 29.1% 31.7%
% Rural 70.9% 68.3%
% Bangkok 15.8% 17.1%
% Central 16.9% 17.4%
% North 19.1% 19.4%
% Northeast 35.2% 35.0%
% South 12.9% 11.1%
Mean Age (years) 51.5 51.8
% Male 70.1% 70.1%
% Couple 73.9% 75.2%
% Primary educated 73.9% 71.2%
% Secondary educated 14.2% 15.2%
% Higher educated 11.8% 13.6%
Household head
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Effect on per capita income
Thailand –whole country
Health shock Unearned Earned Total
Dead: Any HH members 0.778 -0.333 0.053
Ill: Any HH members 0.556 0.259 0.073
Ill: HH head 0.575 0.301 0.208
Ill: Other than head 0.040 -0.027 -0.175
Ill: Working member 0.357 0.143 0.083
Hospitalized: Any HH members 0.488 0.097 0.223
Hospitalized: HH head 0.641 -0.201 0.219
Hospitalized: Other than head 0.235 0.355 0.176
Hospitalized: Working member 0.380 -0.020 0.184
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Effect on per capita incomeThailand –urban vs. rural
Health shock Unearned Earned Total
Dead: Any HH members 0.745 -0.943 -0.393
Hospitalized: Any HH members 0.652 -0.153 -0.037
Hospitalized: HH head 0.536 -0.438 0.017
Hospitalized: Other than head 0.617 0.142 -0.078
Hospitalized: Working member 0.280 -0.118 -0.027
Dead: Any HH members 0.751 -0.106 0.177
Hospitalized: Any HH members 0.448 0.183 0.334
Hospitalized: HH head 0.698 -0.139 0.289
Hospitalized: Other than head 0.108 0.444 0.299
Hospitalized: Working member 0.414 -0.023 0.233
Ru
ral
U
rba
n
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Effect on per capita health spending (W2)
Thailand –whole country
Health shock (W1)Catast.
exp.
Positive
exp.
Exp.
if positive
Overall
exp.
Ill: Any HH members 0.009 0.088 0.136 0.767
Ill: HH head 0.007 0.070 0.108 0.611
Ill: Other than head 0.004 0.034 0.046 0.302
Ill: Working member 0.011 0.089 0.135 0.775
Hospitalized: Any HH members 0.017 0.053 0.154 0.517
Hospitalized: HH head 0.017 0.052 0.208 0.528
Hospitalized: Other than head 0.014 0.042 0.066 0.390
Hospitalized: Working member 0.018 0.049 0.170 0.488
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Effect on per capita health spending (W2)
Thailand –urban vs. rural
Health shock (W1)Catast.
exp.
Positive
exp.
Exp.
if positive
Overall
exp.
Hospitalized: Any HH members 0.020 0.039 0.227 0.478
Hospitalized: HH head 0.026 0.024 0.306 0.407
Hospitalized: Other than head 0.009 0.044 0.107 0.439
Hospitalized: Working member 0.003 0.015 0.070 0.176
Hospitalized: Any HH members 0.017 0.058 0.130 0.530
Hospitalized: HH head 0.013 0.062 0.174 0.569
Hospitalized: Other than head 0.016 0.042 0.054 0.371
Hospitalized: Working member 0.023 0.059 0.208 0.580
Ru
ral
U
rba
n
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Effect on per capita health spending (W3)
Thailand –CS vs. SS vs. UC
Health shock (W2)Catast.
exp.
Positive
exp.
Exp.
if positive
Overall
exp.
Ill: Any HH members 0.024 0.122 0.210 1.092
Ill: HH head 0.0007 0.042 0.213 0.435
Ill: Any HH members 0.017 0.070 0.167 0.655
Ill: HH head 0.004 0.070 0.182 0.627
Ill: Any HH members 0.016 0.068 0.292 0.695
Ill: HH head 0.018 0.047 0.326 0.549
UC
SS
C
S
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Effect on per capita non-health spending
Thailand –whole country
Health shock Food Nonfood
Dead: Any HH members -0.124 0.216
Ill: Any HH members -0.030 0.005
Ill: HH head 0.026 0.059
Ill: Other than head -0.079 -0.073
Ill: Working member -0.0004 0.062
Hospitalized: Any HH members -0.098 -0.073
Hospitalized: HH head -0.058 -0.009
Hospitalized: Other than head -0.114 -0.116
Hospitalized: Working member -0.080 0.005
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Effect on per capita non-health spending
Thailand –urban vs. rural
Health shock Food Nonfood
Dead: Any HH members -0.115 -0.324
Hospitalized: Any HH members -0.104 -0.215
Hospitalized: HH head 0.024 -0.099
Hospitalized: Other than head -0.198 -0.275
Hospitalized: Working member -0.032 -0.083
Dead: Any HH members -0.120 0.415
Hospitalized: Any HH members -0.100 -0.026
Hospitalized: HH head -0.090 0.017
Hospitalized: Other than head -0.086 -0.060
Hospitalized: Working member -0.099 0.029
Ru
ral
U
rba
n
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Effect on per capita education spending
Thailand –whole country
Health shockPositive
exp.
Exp.
if positive
Overall
exp.
Dead: Any HH members -0.043 -0.164 -0.432
Ill: Any HH members -0.026 0.028 -0.214
Ill: HH head -0.036 0.057 -0.304
Ill: Other than head 0.012 -0.029 0.098
Ill: Working member -0.057 0.062 -0.465
Hospitalized: Any HH members -0.024 -0.057 -0.248
Hospitalized: HH head -0.026 0.063 -0.198
Hospitalized: Other than head -0.017 -0.144 -0.239
Hospitalized: Working member -0.048 0.070 -0.385
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Effect on per capita education spending
Thailand –urban vs. rural
Health shockPositive
exp.
Exp.
if positive
Overall
exp.
Dead: Any HH members -0.045 -0.426 -0.608
Hospitalized: Any HH members -0.073 -0.318 -0.832
Hospitalized: HH head -0.058 -0.236 -0.614
Hospitalized: Other than head -0.072 -0.331 -0.852
Hospitalized: Working member -0.098 -0.149 -0.991
Dead: Any HH members -0.039 -0.109 -0.345
Hospitalized: Any HH members -0.007 0.020 -0.037
Hospitalized: HH head -0.014 0.147 -0.052
Hospitalized: Other than head 0.002 -0.089 -0.015
Hospitalized: Working member -0.029 0.129 -0.166
Ru
ral
U
rba
n
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VHLSS (Vietnam Household Living Standards Survey)
Coping Strategies
Source: VHLSS 2006 Report
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Paper 5
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(coping strategies)C = 2,580/2,760 = 0.93
Mean of proportion of exp. financed by coping
Coping-adjusted health expenditure ratio (P)(High spending households)
P
= unadjusted
C
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Cumulative distributions of health expenditure ratiosw = Unadjusted; P = Coping-adjusted
(w)
(P)
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