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The impact of private health insurers on the quality of Russian regional health systems

Galina Besstremyannaya and Jaak Simm
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Jaak Simm: Tokyo Institute of Technology, Graduate School of Information Science and Engineering

No w0177, Working Papers from New Economic School (NES)

Abstract: The 1991 law ‘On health insurance for the citizens of the Russian Federation’ established that social health insurance is to be offered by multiple private insurance companies. The paper is the first econometric analysis measuring the effect of private health insurers on quality related outcomes of social health insurance (SHI) systems in Russian regions. The baseline model introduces regional SHI system as a binary variable with unity value corresponding to the presence of private health insurers as the only agents at the SHI market. The extended model captures endogeneity by employing an instrumental variable approach. The non-parametric model uses kernel regressions. The results of parametric and kernel regressions reveal that the presence of private insurers is a significant determinant of infant and under-five mortality. The positive impact of private insurers is explained by regional institutional reforms. The methods of provider reimbursement are related to infant and under-five mortality, which offers suggestive evidence for enabling insurer competition through selective contracting with health care providers.

Keywords: social health insurance; infant mortality; under-five mortality; kernel regression; health care systems; health care quality; provider payment (search for similar items in EconPapers)
JEL-codes: G22 I10 I18 R22 (search for similar items in EconPapers)
Pages: 22 pages
Date: 2012-09
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