the vulnerability of the uninsured to health shocks in peru · the vulnerability of the uninsured...

The vulnerability of the uninsured to health shocks in Peru

Juan José Diaz, Martin Valdivia*

* Both authors are senior researchers at GRADE, Lima, Peru. This report is part of the studies the authors are developing under the multi-country research project titled "Health Financing, Equity and Poverty in Latin America", which is coordinated by FUNSALUD with financial support from the International Development Research Centre (IDRC). The autors acknowledge excellent research assistence by César Mora, Paola Vargas and Rosa Vidarte. Usual disclaimer applies.

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Figure 1: The vulnerability of the poor/uninsured to health shocks

Health

Care

Needs

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- Insurance

- Quality HC

Health

Shock

Income

Loss

Use of Health

Care Services

Financing

Health Care

Death

Deteriorated

Health Status

/Wellbeing

Social Protection

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Mean CI

OOPHE (annual soles) 812.1 0.411

Total expenditures (annual soles) 18072.5 0.324

CHE HR CI

W-vD method

20% 0.163 -0.449

30% 0.123 -0.610

40% 0.103 -0.713

Xu method

20% 0.101 -0.196

30% 0.057 -0.318

40% 0.035 -0.422

Hybrid method

20% 0.094 -0.139

30% 0.053 -0.279

40% 0.034 -0.399

Impoverishing health expenditures 0.008 -0.669

Source: ENAHO 2006

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0 .2 .4 .6 .8 1Cumulative proportion of population, ordered by total expenditure

Wagstaff-Doorslaer Xu

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.2.4

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1


20% 30%

40% Perfect equality

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W-vD Xu

(1) (2) (1) (2)

Residence area

Urban (=1 if urban) 0.000 0.001 0.004 0.005

(0.03) (0.21) (1.32) (1.36)

Income quintile

Quintile 2 -0.118 -0.119 -0.022 -0.022

(35.97)*** (35.90)*** (6.30)*** (6.22)***

Quintile 3 -0.132 -0.134 -0.047 -0.048

(36.05)*** (36.14)*** (12.61)*** (12.69)***

Quintile 4 -0.129 -0.133 -0.049 -0.051

(32.51)*** (33.36)*** (12.07)*** (12.75)***

Quintile 5 (richest) -0.117 -0.123 -0.048 -0.053

(26.39)*** (28.84)*** (10.37)*** (12.25)***

Household composition

with children under 5 0.039 0.031 0.023 0.018

(7.61)*** (6.34)*** (5.63)*** (4.58)***

with elders (above 65) 0.031 0.032 0.025 0.026

(4.89)*** (5.06)*** (5.12)*** (5.18)***

Both 0.070 0.068 0.048 0.046

(6.49)*** (6.26)*** (5.48)*** (5.26)***

Household size

3 - 4 members 0.041 0.034 0.019 0.014

(5.96)*** (5.01)*** (3.62)*** (2.76)***

5 or more 0.066 0.057 0.022 0.016

(9.39)*** (8.18)*** (4.26)*** (3.16)***

Insurance

% hh members with insurance -0.047 -0.032

(6.89)*** (6.07)***

# observations 20577 20577 20577 20577

Pseudo R2 0.27 0.27 0.06 0.06

Notes: Marginal effects reported. Absolute value of t statistics in parentheses

* significant at 10%; ** significant at 5%; *** significant at 1%

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Only

All adults Head's partner Head's partner Head's partner Head's partner

present not present present not present

(N=3066) (N=980) (N=1735) (N=351) (N=1369) (N=151)

Change in chronic conditions

Any member becomes ill 0.258 0.257 0.261 0.248 0.240 0.199

Any member 14-55 years becomes ill 0.156 0.124 0.176 0.145 0.178 0.126

Head becomes ill 0.108 0.132 0.089 0.137 0.077 0.119

Head's partner becomes ill 0.178 0.202 0.173 0.155

Adverse events reported by the head

Death of a member 0.008 0.009 0.002 0.031 0.002 0.046

Any member severly ill 0.053 0.061 0.049 0.048 0.050 0.040

Notes: The table reports the percentage of households that suffer a deterioration on the health status of their members. We define the deterioration

of the health status of a household member by the occurrence of a new chronic disease using information from the health section from ENAHO. We

also use the report on deaths and the occurrence of severe illness for household memebres given by the household head in the section on adverse

events from ENAHO.

With children With children of the head

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Only



(N=3066) (N=980) (N=1735) (N=351) (N=1369) (N=151)

Any member becomes ill 0.665 0.774 0.501 1.375 0.510 1.466

(0.118) (0.246) (0.142) (0.376) (0.165) (0.690)

Any member 14-55 years becomes ill 0.631 0.865 0.442 1.446 0.516 1.935

(0.142) (0.329) (0.162) (0.451) (0.183) (0.815)

Head becomes ill 0.733 0.890 0.416 1.449 0.311 1.915

(0.165) (0.313) (0.219) (0.466) (0.263) (0.843)


(0.182) (0.383) (0.200) (0.236)

Death of a member -0.458 -1.140 -1.845 -0.106 -0.741 -0.282

(0.593) (1.087) (1.483) (0.966) (1.827) (1.367)

Any member severly ill -0.453 -0.310 -0.545 -0.904 -0.363 0.296

(0.227) (0.434) (0.285) (0.754) (0.321) (1.413)


Notes: Standard errors in parentheses. Coefficients estimated from separated first differenced regressions of the change in per capita medical

expenditures on health shocks and additional covariates.!

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(N=3066) (N=980) (N=1735) (N=351) (N=1369) (N=151)

Any member becomes ill 0.142 0.159 0.134 0.426 0.028 -0.059

(0.087) (0.200) (0.086) (0.343) (0.096) (0.519)

Any member 14-55 years becomes ill 0.040 -0.025 -0.020 0.829 -0.106 -0.121

(0.105) (0.267) (0.099) (0.407) (0.107) (0.616)

Head becomes ill -0.045 -0.137 -0.012 0.327 -0.117 -0.364

(0.122) (0.254) (0.133) (0.423) (0.153) (0.635)

Head's partner becomes ill 0.045 0.200 -0.024 -0.033

(0.135) (0.309) (0.122) (0.138)

Death of a member -0.133 -0.083 -1.735 0.157 -0.779 -0.120

(0.437) (0.877) (0.902) (0.864) (1.063) (1.008)

Any member severly ill 0.054 -0.158 0.341 -0.225 0.409 0.638

(0.168) (0.350) (0.173) (0.676) (0.187) (1.040)


Notes: Standard errors in parentheses. Coefficients estimated from separated first differenced regressions of the change in per capita family labor

earnings on health shocks and additional covariates.!

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(N=3066) (N=980) (N=1735) (N=351) (N=1369) (N=151)

Any member becomes ill 0.057 0.053 0.064 -0.025 0.086 -0.113

(0.019) (0.040) (0.024) (0.061) (0.027) (0.106)

Any member 14-55 years becomes ill 0.039 0.031 0.047 -0.058 0.068 -0.156

(0.023) (0.054) (0.027) (0.073) (0.030) (0.126)

Head becomes ill 0.028 0.004 0.062 -0.072 0.066 -0.204

(0.027) (0.051) (0.037) (0.075) (0.044) (0.129)


(0.030) (0.062) (0.033) (0.039)

Death of a member -0.215 -0.311 -0.443 -0.126 -0.291 0.048

(0.098) (0.177) (0.247) (0.154) (0.302) (0.207)

Any member severly ill -0.020 -0.004 -0.017 -0.093 -0.033 0.118

(0.037) (0.071) (0.048) (0.120) (0.053) (0.213)

Notes: Standard errors in parentheses. Coefficients estimated from separated first differenced regressions of the change in per capita

non-medical expenditures on health shocks and additional covariates.


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Only



(N=3066) (N=980) (N=1735) (N=351) (N=1369) (N=151)

Any member becomes ill 0.403 0.335 0.473 -0.059 3.037 1.924

(0.268) (0.476) (0.317) (0.155) (10.190) (16.792)

Any member 14-55 years becomes ill 0.966 -1.243 -2.352 -0.070 -0.640 1.292

(2.507) (13.732) (11.919) (0.098) (0.767) (6.452)

Head becomes ill -0.631 -0.031 -5.224 -0.221 -0.566 0.561

(1.909) (0.381) (59.148) (0.383) (0.903) (0.973)

Head's partner becomes ill 1.815 0.676 -2.028 -2.133

(5.402) (1.069) (10.726) (9.131)

Death of a member 1.615 3.749 0.255 -0.799 0.373 -0.399

(5.262) (39.535) (0.173) (4.580) (0.567) (4.090)

Any member severly ill -0.364 0.026 -0.050 0.415 -0.080 0.185

(1.409) (0.446) (0.147) (1.312) (0.143) (0.402)

Notes: Standard errors in parentheses. Coefficients estimated from separated first differenced regressions of the change in per capita

non-medical expenditures on non-medical family labor earnigs. All regressions estimated by 2SLS, using health shocks as the

instrumental variables for labor earnings. All regressions include additional covariates as described in the text.


!

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References

;#3*#6!T,)&-)#$g!FE!D#=W#,0! U788YVE! K;&1$"3! ,(9<)<:+=!>9$*&#*)"?!5$(,&5$+3,! 79$%!5&:+*5!

,5$#@,!)"!/:*)"!A%&9)#:BE![%,/0!;#$W6![#&<)$I-%$!(ETE!

;)-,#$!e! @&%=)#0%&! U788fVE! K!%8:#*! $7! C&:+*5! !",(9:"#&! $"! A##&,,! *$! C&:+*5! -&9<)#&,D!

C&:+*5! -&9<)#&,! E,&! :"3! C&:+*5! -*:*(,! )"! *5&! F&<&+$8)"?!G$9+3=! .:,&! -*(31! 79$%!

>&9(NE! +#$"&=,)G-6! >/%4#/! L3#/-<! 2)$#$=)$I! S$)-)#-)136! ;,%%W)$I&! S$&-)-"-)%$6!

R3G-3C43,E!

T%X6! (%$#/0g! +#,=3/! 2#H=<#CG&! U788fVE! KAX-3$030! 2#C)/5! #$0! l)$&<)G! Q3-O%,W&^!

A=%$%C)=! S$&)I<-&!#$0!A1%/"-)%$#,5!(),3=-)%$&NE! S$!R=<"/-*6!FE!D#"/!#$0! !%<$!R-,#"&&!

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Quintil

Indicator 1

(poorest) 2 3 4 5 (richest)

Individual Health module

Any member becomes ill 0.22 0.18 0.23 0.30 0.31

Any member 14-55 years becomes ill 0.10 0.11 0.13 0.20 0.19

Head becomes ill 0.11 0.08 0.09 0.11 0.12

Head's partner becomes ill 0.07 0.06 0.08 0.09 0.09

Household module on perceptions

Death of a member 0.03 0.01 0.01 0.01 0.09

Any member severely ill 0.18 0.20 0.32 0.32 0.10

Source: ENAHO 2002-03

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