Europe and Central Asia's Great Post-Communist Social Health Insurance Experiment : Impacts on Health Sector and Labor Market Outcomes
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World Bank, Washington, DC
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The post-communist transition to social
health insurance in many of the Central and Eastern European
and Central Asian countries provides a unique opportunity to
try to answer some of the unresolved issues in the debate
over the relative merits of social health insurance and
tax-financed health systems. This paper employs a
regression-based generalization of the
difference-in-differences method and instrumental variables
on panel data from 28 countries for the period 1990-2004.
The authors find that, controlling for any concurrent
provider payment reforms, adoption of social health
insurance increased national health spending and hospital
activity rates, but did not lead to better health outcomes.
The authors also find that adoption of social health
insurance reduced employment in the economy as a whole and
increased unemployment, although it did not apparently
increase the size of the informal economy.
Palabras clave
AGED, APPENDICITIS, ARI, BREAST CANCER, BRONCHITIS, CAESAREAN SECTIONS, CANCERS, CAPITA HEALTH SPENDING, CAPITAL SPENDING, CENTRAL ASIAN, CENTRAL FUND, CEREBROVASCULAR DISEASES, CONTRACTS WITH PROVIDERS, CONTRIBUTION RATES, COST OF HEALTH CARE, DEATH RATES, DEATHS, DELIVERY OF HEALTH CARE, DEVELOPING COUNTRIES, DIABETES, DIAGNOSIS, DIARRHOEA, DIGESTIVE DISEASES, DISABILITY, DISEASE, DIVORCE, DRUGS, FEE-FOR-SERVICE, FINANCIAL RESOURCES, GI, HEALTH CARE, HEALTH CARE EXPENDITURES, HEALTH CARE RESOURCES, HEALTH CARE SPENDING, HEALTH CONDITIONS, HEALTH ECONOMISTS, HEALTH EXPENDITURE, HEALTH EXPENDITURE PER CAPITA, HEALTH EXPENDITURES, HEALTH EXPENDITURES PER CAPITA, HEALTH FINANCING, HEALTH FINANCING SYSTEM, HEALTH FOR ALL, HEALTH INDICATORS, HEALTH INFORMATION, HEALTH INSURANCE, HEALTH INSURERS, HEALTH MINISTRIES, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH POLICIES, HEALTH POLICY, HEALTH PROFESSIONALS, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SECTOR REFORM, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH SYSTEMS IN TRANSITION, HEALTH WORKERS, HEART DISEASE, HEPATITIS, HEPATITIS B, HOSPITAL, HOSPITAL ADMISSIONS, HOSPITAL BEDS, HOSPITAL CARE, HOSPITALIZATION, HOSPITALS, HUMAN DEVELOPMENT, ILLNESS, IMMUNIZATION, IMPACT ON HEALTH, INCOME, INCOME GROUPS, INFANT, INFANT MORTALITY, INFANT MORTALITY RATE, INFECTION, INFECTION RATE, INFECTION RATES, INFECTIOUS DISEASES, INFORMAL SECTOR, INPATIENT ADMISSIONS, INSURANCE FUNDS, INTERNATIONAL LABOR ORGANIZATION, INTERNATIONAL ORGANIZATIONS, LABOR MARKET, LABOR MARKETS, LABOR SUPPLY, LATIN AMERICAN, LAWS, LIFE EXPECTANCY, LIVER, LIVER DISEASES, LOW INCOME, MEASLES, MEASLES IMMUNIZATION, MINISTRY OF HEALTH, MORBIDITY, MORBIDITY INDICATORS, MORTALITY, MUMPS, NATIONAL HEALTH, NATIONAL HEALTH SPENDING, NEGATIVE EFFECTS, NEONATAL MORTALITY, NEOPLASMS, PATIENT, PATIENT ADMISSIONS, PATIENTS, PAYMENTS FOR HEALTH CARE, PENSIONS, PERTUSSIS, PHYSICIANS, POCKET PAYMENTS, POLICY RESEARCH, POLICY RESEARCH WORKING PAPER, POLIO, PREVALENCE, PRIMARY CARE, PRIVATE SECTOR, PRIVATE SECTORS, PRIVATE SPENDING, PROBABILITY, PROGRESS, PROVIDER PAYMENT, PROVISION OF HEALTH CARE, PUBLIC HEALTH, PUBLIC SERVICES, PURCHASING POWER, PURCHASING POWER PARITY, QUALITY OF CARE, RESPECT, RESPIRATORY DISEASES, RUBELLA, SHARE OF HEALTH SPENDING, SMOKING, SOCIAL HEALTH INSURANCE, SOCIAL SECURITY, SUBSISTENCE FARMING, SYPHILIS, TETANUS, TREATMENT, TUBERCULOSIS, UNDER-FIVE MORTALITY, UNEMPLOYMENT, UNEMPLOYMENT RATES, URBAN POPULATION, VISION, WAR, WORKERS, WORLD HEALTH ORGANIZATION