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Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting

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  • Steven F. Koch
  • Jeffrey S. Racine
Abstract
We apply parametric and nonparametric regression discontinuity methodology within a multinomial choice setting to examine the impact of public health care user fee abolition on health facility choice using data from South Africa. The nonparametric model is found to outperform the parametric model both in- and out-of-sample, while also delivering more plausible estimates of the impact of user fee abolition (i.e. the 'treatment effect'). In the parametric framework, treatment effects were relatively constant - around 7% - and that increase was drawn equally from both home care and private care groups. On the other hand, in the nonparametric framework treatment effects were largest for the least well-off (also around 7%) but fell for the most well-off. More plausibly, that increase was drawn primarily from the home care group, suggesting that the policy favoured those least well-off as more of these children received at least some minimum level of professional health care after the policy was implemented. Regarding the most well-off, despite having access to free public health care, children were still far more likely to receive health care at private facilities than at public facilities, which is also more plausible in South Africa's two-tier health sector.

Suggested Citation

  • Steven F. Koch & Jeffrey S. Racine, 2013. "Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting," Department of Economics Working Papers 2013-14, McMaster University.
    • Handle: RePEc:mcm:deptwp:2013-14
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    References listed on IDEAS

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    Cited by:

    1. Steven F Koch & Naomi Setshegetso, 2020. "Catastrophic health expenditures arising from out-of-pocket payments: Evidence from South African income and expenditure surveys," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-14, August.
    2. Steven F. Koch & Naomi Setshegetso, 2021. "Progressivity of out-of-pocket payments and its determinants decomposed over time," Development Southern Africa, Taylor & Francis Journals, vol. 38(5), pages 731-749, September.
    3. Jonah S. Goldberg, 2023. "What we measure when we measure the effects of user fees: a replication, reanalysis, and extension of Tanaka, 2014," Empirical Economics, Springer, vol. 65(4), pages 1981-2009, October.
    4. Steven F. Koch, 2017. "User Fee Abolition and the Demand for Public Health Care," South African Journal of Economics, Economic Society of South Africa, vol. 85(2), pages 242-258, June.
    5. Xu, Ke-Li, 2017. "Regression discontinuity with categorical outcomes," Journal of Econometrics, Elsevier, vol. 201(1), pages 1-18.
    6. Cory Koedel & Jiaxi Li & Matthew G. Springer & Li Tan, 2016. "The Impact of Performance Ratings on Job Satisfaction for Public School Teachers," Working Papers 1617, Department of Economics, University of Missouri.
    7. Goeun Lee & Myoung-jae Lee, 2023. "Regression Discontinuity for Binary Response and Local Maximum Likelihood Estimator to Extrapolate Treatment," Evaluation Review, , vol. 47(2), pages 182-208, April.
    8. Gelo, Dambala & Kollamparambil, Umakrishnan & Jeuland, Marc, 2023. "The causal effect of income on household energy transition: Evidence from old age pension eligibility in South Africa," Energy Economics, Elsevier, vol. 119(C).
    9. Aistov, Andrey, 2019. "Happy together: A regression discontinuity approach," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 53, pages 73-99.

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    JEL classification:

    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models
    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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