Essays on Social Protection and Health Insurance
Restricted (Penn State Only)
- Author:
- James, Nigel
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 05, 2024
- Committee Members:
- Chris Hollenbeak, Program Head/Chair
Jeannette Rogowski, Major Field Member
Stephen Matthews, Outside Field Member
Yubraj Acharya, Chair & Dissertation Advisor
Brian Thiede, Outside Unit Member - Keywords:
- non-contributory pension
mental health
depression
geriatric
regression discontinuity
difference-in-differences
social pension schemes
health insurance
ANC
quality of care
spatial analysis
UHC
subsidy
diarrhea
fever
acute respiratory infection
child health
health insurance - Abstract:
- My dissertation aims to expand knowledge on how social protection and health insurance policy tools can contribute to sustainable development financing, enhance health systems, and reduce inequalities. Organized in five chapters, the core of this dissertation centers on Chapters 2 through 4, each focusing on investigating various aspects of social protection and health insurance programs within the context of low-and middle-income countries (LMICs). In Chapter 1, I provide a synopsis of the overarching objectives of the dissertation, highlighting the social protection and health insurance policy landscape in Low- and Middle-Income Countries (LMICs). Chapter 2 focuses on rural Mexico. I apply the regression discontinuity causal inference technique to evaluate the impact of non-contributory social pensions on mental health among older adults. My analysis reveals that the Mexican old-age non-contributory social pension program did not significantly reduce depressive symptoms among beneficiaries. Given the rapidly growing share of the elderly population in LMICs, my findings can shape policy discussions on pensions and other social welfare programs, including how these programs can be adapted to promote healthy aging. In Chapter 3, we examine the impact of antenatal care quality on health insurance enrollment in Namibia. We use geospatial techniques to link health facility characteristics to household data. Our findings indicate that the quality of care is not significantly associated with insurance uptake. Nevertheless, we find substantial variation in the impact of quality of care on health insurance enrollment across regions with differing health facility densities. Additionally, we find that the likelihood of having insurance consistently increases with rising wealth and higher levels of educational attainment, irrespective of the quality of care. Governments should prioritize interventions to expand health insurance coverage, focusing on affordability through measures like premium subsidies and increasing awareness of the importance of insurance. In Chapter 4, we investigate the associations between health insurance and childhood illnesses, treatment-seeking behaviors, and key hypothesized causal mechanisms in Zimbabwe. We find that health insurance is negatively associated with the occurrence of diarrhea and fever, but not cough. Sub-group analyses show that insurance effects on diarrheal illness are concentrated among girls and children in urban areas, and effects on fever are concentrated among boys. We find no evidence that health insurance coverage increases the likelihood that sick children access treatment. Furthermore, our results indicate that the relationship between health insurance and childhood illnesses is mediated by factors like accessibility and cost, partly explaining the observed effects. These findings highlight the potential of expanding health insurance as an untapped strategy for improving child health in Zimbabwe and other similar contexts. Collectively, this research emphasizes the importance of enhancing the way social protection and health insurance programs are implemented, including integrating these programs with initiatives that address non-financial barriers to accessing care, all aimed at meeting the changing needs of the targeted populations.