Alkenbrack Sarah, Lindelow Magnus
Futures Group, Washington, DC, USA.
Health Econ. 2015 Apr;24(4):379-99. doi: 10.1002/hec.3023. Epub 2013 Dec 19.
Community-based health insurance in Lao People's Democratic Republic targets the informal workforce. Estimates of the program's impact on utilization and out-of-pocket expenditures (OOPs) were obtained using a case-comparison study of 3000 households (14 804 individuals) in urban and semi-urban areas. We used propensity score matching to control for bias on observables and to account for heterogeneity. We check the sensitivity of the results using a weighted regression combined with propensity score matching, which leads to doubly robust treatment effect estimates. The results are robust across the two approaches and show that the insured have significantly higher utilization, lower OOPs and lower incidence of catastrophic expenditures, and are less likely to employ coping mechanisms. However, coverage of the scheme is extremely low, indicating negligible population level impact. Furthermore, the results show that the scheme provides greater protection to the better off than to the poor: the poor are less likely to enrol, and among the poor who are enrolled, there has been no significant impact on utilization of outpatient services, total OOPs or catastrophic expenditures. We discuss the policy implications in the context of the international debate regarding the prospects for the role of community-based health insurance in national financing strategies.
老挝人民民主共和国的社区医疗保险以非正规劳动力为目标群体。通过对城市和半城市地区3000户家庭（14804人）进行案例比较研究，得出了该计划对医疗服务利用和自付费用影响的估计值。我们使用倾向得分匹配法来控制可观测因素的偏差并考虑异质性。我们通过结合倾向得分匹配的加权回归来检验结果的敏感性，从而得到双重稳健的治疗效果估计值。两种方法的结果都很稳健，表明参保者的医疗服务利用率显著更高，自付费用更低，灾难性支出发生率更低，而且采用应对机制的可能性更小。然而，该计划的覆盖范围极低，表明对总体人口的影响微乎其微。此外，结果表明该计划为较富裕人群提供的保护比对贫困人口更多：贫困人口参保的可能性较小，而且在已参保的贫困人口中，该计划对门诊服务利用、总自付费用或灾难性支出均无显著影响。我们在关于社区医疗保险在国家筹资战略中的作用前景的国际辩论背景下讨论了政策含义。
