Health care access and demand

Abstract

newline Providing access to affordable and equitable health care, is a goal which still remains achallenge for nations across the globe. Given the benefits of a good health care system,domestic policies as well as cross-border flows in health services can help improve accessto the health care system. This thesis examines the channels for this impact on access tohealthcare.In the context of domestic policies, we examine the impact of a social health insurancescheme introduced by the government of India in 2008. Using a large nationally representative panel data based on a household survey and difference-in-difference estimation strategy,we find that RSBY increased the likelihood of hospitalization and led to a greater proportion of members in a household opting for hospitalization in case of long-term illnesses. Wealso find that RSBY households are more likely to get treated by a doctor for short-termillnesses. Our findings further show that monthly per-capita total out-of-pocket (OOP) expenditure of households increases. This occurs due to more patient-doctor contact amongRSBY households and increased awareness on the part of the insured households regarding their healthcare needs. Using a quantile difference-in-difference estimation strategy, wealso find that this increase in expenditure is higher at the top conditional distribution ofOOP spending. On the other hand, the positive impact of increased hospitalization andtreatment by a doctor is reflected by a decline in the number of days lost due to illness.Further, using a variety of robustness tests we ensure that the results are indeed driven bythe implementation of RSBY.In the context of cross border trade in health services, we present a model of trade inhealth services, adopting the Heckscher-Ohlin general equilibrium framework.