Waters H R
CRS-Peru, Baltimore, MD 21201, USA.
Health Econ. 1999 Aug;8(5):473-83. doi: 10.1002/(sici)1099-1050(199908)8:5<473::aid-hec453>3.0.co;2-c.
This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status. The setting for the study is the country of Ecuador. The General Health Insurance (GHI) programme, which primarily covers workers in the formal sector of the economy, is found to have a strong positive association with the use of curative health care after correcting for selection bias, but no significant effect on the use of preventive care. Individuals with severe illnesses who are eligible for GHI have a preference for private health care, and self-select out of the GHI programme. The Seguro Campesino Social (SSC) programme, directed at farming populations, has positive but insignificant associations with both curative and preventive care.
本文开发并运用方法来评估公共融资医疗保险计划对医疗保健利用的影响。该研究使用单变量和双变量概率估计技术，检验并校正了由选择偏差导致的内生性问题。潜在的内生性源于参保选择、保险资格以及个人健康状况的差异。研究背景是厄瓜多尔。一般医疗保险（GHI）计划主要覆盖经济正规部门的工人，在校正选择偏差后，该计划被发现与治疗性医疗保健的利用有很强的正相关关系，但对预防性保健的利用没有显著影响。符合GHI资格的重症患者偏好私立医疗保健，并自行退出GHI计划。面向农业人口的社会农民保险（SSC）计划与治疗性和预防性保健都有正向但不显著的关联。
