Dataset Information

Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru.

ABSTRACT: 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.

SUBMITTER: Anaya-Montes M

PROVIDER: S-EPMC11349220 | biostudies-literature | 2024

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru.

Anaya-Montes Misael M Gravelle Hugh H

PloS one 20240827 8

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 ...[more]

PMID: 39190748

Similar Datasets

Project description:IntroductionCovid-19 has had devastating effect on health systems and health utilization globally. Maternal and newborn care were adversely affected but little or nothing is known about the impact it has caused to it. This study seeks to determine the effect of Covid-19 on healthcare utilization with specifics on Antenatal, Postnatal, Deliveries and Out-patient attendance.MethodsThe study uses secondary data obtained from the four (4) Claims Processing Centres of the National Health Insurance Authority. Through the use of convenient sampling, a total of 502 facilities were selected for inclusion in the research. The study used a longitudinal claims submitted from a cross-section of health facilities namely Community-Based Health Planning and Services, Maternity Homes, Health Centers, Clinics, Primary, Secondary, and Tertiary Hospitals for Antenatal, Postnatal, Out-patient consultations and Delivery attendances from January 2018 to December 2021. Data before and during the Covid-19 pandemic were compared. Segmented regression analysis as an interrupted time series analysis was employed to assess the effect of the pandemic on utilization of services.ResultsThe results indicate that Covid-19 had a significant impact on healthcare utilization in Ghana. Month-on-month, antenatal and out-patient utilization decreased by 21,948.21 and 151,342.40, respectively. Postnatal and delivery services saw an insignificant monthly increase of 37.76 and 1,795.83 from the onset of the covid-19 pandemic and the introduction of movement restrictions. This decline was observed across all care levels, except for Community-Based Health Planning and Services, which showed a slight increase. Also, the results indicate projected average misses of scheduled antenatal, postnatal, out-patient reviews, and deliveries at 21,037.75, 6,428.23, 141,395.30 and 4,745.63 patients respectively.ConclusionThe study reveals that Covid-19 led to a decrease in utilization of healthcare which affected pregnant women and newborn care as well. It was evident from the results that community-based healthcare is more resilient and efficient in delivering healthcare amidst the pandemic. In our quest to achieve Universal Health Coverage by 2030, Ghana's health system should improve on the community-based healthcare system and include technology in its healthcare delivery for the people.

Project description:ObjectiveTo improve understanding of the relationship between lack of insurance and risk of subsequent mortality.Data sourcesAdults who reported being uninsured or privately insured in the National Health Interview Survey from 1986 to 2000 were followed prospectively for mortality from initial interview through 2002. Baseline information was obtained on 672,526 respondents, age 18-64 at the time of the interview. Follow-up information on vital status was obtained for 643,001 (96 percent) of these respondents, with approximately 5.4 million person-years of follow-up.Study designRelationships between insurance status and subsequent mortality are examined using Cox proportional hazard survival analysis.Principal findingsAdjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance at baseline (hazard ratio 1.03, 95 percent confidence interval [CI], 0.95-1.12). Omitting health status as a control variable increases the estimated hazard ratio to 1.10 (95 percent CI, 1.03-1.19). Also omitting smoking status and body mass index increases the hazard ratio to 1.20 (95 percent CI, 1.15-1.24). The estimated association between lack of insurance and mortality is not larger among disadvantaged subgroups; when the analysis is restricted to amenable causes of death; when the follow-up period is shortened (to increase the likelihood of comparing the continuously insured and continuously uninsured); and does not change after people turn 65 and gain Medicare coverage.ConclusionsThe Institute of Medicine's estimate that lack of insurance leads to 18,000 excess deaths each year is almost certainly incorrect. It is not possible to draw firm causal inferences from the results of observational analyses, but there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.

Dataset Information

Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru.

Publications

Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets