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APLセミナー(アジ研パワーランチセミナー)

APLセミナー(アジ研パワーランチセミナー)は、アジア経済研究所の研究者のみならず、外部の研究者、学生の方にも参加いただけるリサーチワークショップで、お昼の時間にアジア経済研究所（海浜幕張）の会議室で開催しております。

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ジェトロ・アジア経済研究所　APL幹事
今井　宏平　E-mail：kohei_imai
粒良　麻知子　E-mail：Machiko_Tsubura
明日山　陽子　E-mail：yoko_asuyama
成果普及課　Tel：043-299-9536

2016年10月20日 (木曜) 12時30分～14時00分

ジェトロ・アジア経済研究所　C23会議室 　

Background
In 2006 the Government Employees Medical Scheme (GEMS) was introduced and gradually expanded to previously uncovered public sector employees. Public sector employees who indicated that their employer provides medical scheme cover increased from 59% to 73% between 2007 and 2008, stabilising around 77% in 2011. Under GEMS all governmentworkers became eligible for health insurance subsidies and low-earning employees received a full subsidy for the most basic benefit package, Sapphire. Under this scheme, no co-payments were required when using network providers. By the end of 2012, GEMS provided health cover to more than 200,000 government employees and 1.8 million individuals.

Methods
The introduction of GEMS created a natural experiment allowing for the estimation of the causal effect of coverage on health utilisation and provider choices for public sector employees. We exploit the gradual expansion of GEMS to implement an instrumental variable approach in two data sets: a combined version of Labour Force Surveys (LFS) and General Household Surveys (GHS) and the National Income Dynamics Study (NIDS) panel.

Results
As expected in South Africa’s polarised health provider market, insurance causes a large response in both utilisation and provider choice. Our estimates from the two strategies show similar results and provide evidence of a very large impact of insurance cover (62 to 71%) on the utilisation of health services. Insurance increases the likelihood of using private providers and in particular private doctors (66%).

Discussion
This analysis presents the most reliable indication yet of how an expansion of insurance may affect provider choice by lower income households in South Africa. It reveals a strong preference for doctors over public clinics (typically staffed by nurses) under insurance. While the inclusion of networks of doctors will enhance user satisfaction, the observed magnitude of the shifts under insurance cover suggests that rationing measures will be critical for the envisioned National Health Insurance (NHI).

Dr. Anja Smith (Faculty of Management and Economic Sciences, Stellenbosch University)

伊藤　成朗

英語