Ministry of Economics and Finance, Lima, Peru.
Centre for Health Economics, University of York, York, United Kingdom.
PLoS One. 2024 Aug 27;19(8):e0309531. doi: 10.1371/journal.pone.0309531. eCollection 2024.
Peru has a fragmented health insurance system in which most insureds can only access the providers in their insurer's network. The two largest sub-systems covered about 53% and 30% of the population at the start of the pandemic; however, some individuals have dual insurance and can thereby access both sets of providers. We use data on 24.7 million individuals who belonged to one or both sub-systems to investigate the effect of dual insurance on COVID-19 mortality. We estimate recursive bivariate probit models using the difference in the distance to the nearest hospital in the two insurance sub-systems as Instrumental Variable. The effect of dual insurance was to reduce COVID-19 mortality risk by 0.23% compared with the sample mean risk of 0.54%. This implies that the 133,128 COVID-19 deaths in the sample would have been reduced by 56,418 (95%CI: 34,894, 78,069) if all individuals in the sample had dual insurance.
秘鲁的医疗保险体系较为分散，大多数参保人只能在其保险公司网络内的医疗机构就诊。在疫情开始时，两个最大的子系统覆盖了约 53%和 30%的人口；然而，一些人拥有双重保险，可以因此访问这两组医疗机构。我们使用属于这两个子系统之一或两者的 2470 万人的数据，研究双重保险对 COVID-19 死亡率的影响。我们使用两个医疗保险子系统中最近医院的距离差异作为工具变量，估计递归双变量概率模型。与样本平均风险 0.54%相比，双重保险将 COVID-19 死亡率风险降低了 0.23%。这意味着，如果样本中的所有人都拥有双重保险，那么样本中的 133128 例 COVID-19 死亡病例将减少 56418 例（95%CI：34094，78069）。
