Motivation
Empirical analyses
Discussion and Conclusion
Community-based health insurance in Rwanda:
An effective measure ag...
Motivation
Empirical analyses
Discussion and Conclusion
Outline
1 Motivation
Children as insurance asset
Formal health ins...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Outline
1 Moti...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Informal risk ...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Children as in...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Children as in...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Children as in...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Children as in...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Outline
1 Moti...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Literature
For...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Community-base...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Community-base...
Motivation
Empirical analyses
Discussion and Conclusion
Children as insurance asset
Formal health insurance
Community-base...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Outline
1 M...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Data
Data s...
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Discussion and Conclusion
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Robustness check
Two outcome...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
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Robustness check
Hours worke...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Education G...
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Empirical analyses
Discussion and Conclusion
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Estimation results
Robustness check
Estimation ...
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Discussion and Conclusion
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Robustness check
Estimation ...
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Robustness check
Test of end...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Test of end...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Test of end...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Outline
1 M...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Estimation ...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Outline
1 M...
Motivation
Empirical analyses
Discussion and Conclusion
Empirical strategy
Estimation results
Robustness check
Propensity ...
Motivation
Empirical analyses
Discussion and Conclusion
Discussion of results
Policy implications
Limitations and Outlook
...
Motivation
Empirical analyses
Discussion and Conclusion
Discussion of results
Policy implications
Limitations and Outlook
...
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Empirical analyses
Discussion and Conclusion
Discussion of results
Policy implications
Limitations and Outlook
...
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Empirical analyses
Discussion and Conclusion
Discussion of results
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Limitations and Outlook
...
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Empirical analyses
Discussion and Conclusion
Discussion of results
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Limitations and Outlook
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Empirical analyses
Discussion and Conclusion
Discussion of results
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Limitations and Outlook
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Empirical analyses
Discussion and Conclusion
Discussion of results
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Empirical analyses
Discussion and Conclusion
Discussion of results
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Limitations and Outlook
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Empirical analyses
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Discussion of results
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Limitations and Outlook
...
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Empirical analyses
Discussion and Conclusion
Discussion of results
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Limitations and Outlook
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Empirical analyses
Discussion and Conclusion
Discussion of results
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Limitations and Outlook
...
Motivation
Empirical analyses
Discussion and Conclusion
Discussion of results
Policy implications
Limitations and Outlook
...
Appendix References
References I
Akabayashi, H., Psacharopoulos, G. (1999). The trade-off
between child labour and human ca...
Appendix References
References II
de Janvry, A., Financ, F., Sadoulet, E., Vakis, R. (2006). Can
conditional cash transfer...
Appendix References
References III
Guarcello, L., Mealli, F., Rosati, F.C. (2010). Household
vulnerability and child labor...
Appendix References
References IV
Lu, C., Chin,B., Lewandowski, J.L., Basinga, P., Hirschhorn,
L.R., Hill, K., Murray, M.,...
Appendix References
References V
Shimeles, A. (2010). Community based health insurance
schemes in Africa: The case of Rwan...
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Parallel_Session_2_Talk_6_Strobl

  1. 1. Motivation Empirical analyses Discussion and Conclusion Community-based health insurance in Rwanda: An effective measure against child labour? Renate Strobl Department of Health Economics, University of Basel 13 September 2013 Swiss Health Economic Workshop, Lucerne Renate Strobl CBHI in Rwanda: Effective against child labour?
  2. 2. Motivation Empirical analyses Discussion and Conclusion Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  3. 3. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  4. 4. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Informal risk coping strategies Options: 1 Drawing on savings 2 Selling assets 3 Borrowing from the extended family 4 Children as insurance asset: School de-enrolment (→ economizing educational expenditures) Child labour (→ generating income; replacing family members in household production) Renate Strobl CBHI in Rwanda: Effective against child labour?
  5. 5. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Children as insurance asset Ex post risk coping strategy: Income shock ⇒ consumption smoothing agricultural crop shocks (Beegle et al., 2006, Jakoby and Skoufias, 1997) parental health shocks (Bazen and Salmon, 2010, de Janvry et al., 2006) economic crisis (Thomas et al., 2004) Ex ante risk coping strategy: Income risk ⇒ precautionary savings child time allocation is affected even if shocks do not realize Fitzsimons (2007), Kazianga (2012) Renate Strobl CBHI in Rwanda: Effective against child labour?
  6. 6. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Children as insurance asset Ex post risk coping strategy: Income shock ⇒ consumption smoothing agricultural crop shocks (Beegle et al., 2006, Jakoby and Skoufias, 1997) parental health shocks (Bazen and Salmon, 2010, de Janvry et al., 2006) economic crisis (Thomas et al., 2004) Ex ante risk coping strategy: Income risk ⇒ precautionary savings child time allocation is affected even if shocks do not realize Fitzsimons (2007), Kazianga (2012) Renate Strobl CBHI in Rwanda: Effective against child labour?
  7. 7. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Children as insurance asset Significant long-term costs: Child labour is associated with worsened health (O’Donnell et al., 2005) lower educational attainment (Beegle et al., 2008, Zabaleta, 2011) lower cognitive achievements (Akabayashi & Psacharopoulos, 1999, Heady, 2003) Withdrawals from school reduce probability to return to school (de Janvry et al., 2006) ⇒ lower human capital accumulation ⇒ lower future earnings, productivity, well-being; perpetuated poverty Renate Strobl CBHI in Rwanda: Effective against child labour?
  8. 8. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Children as insurance asset Significant long-term costs: Child labour is associated with worsened health (O’Donnell et al., 2005) lower educational attainment (Beegle et al., 2008, Zabaleta, 2011) lower cognitive achievements (Akabayashi & Psacharopoulos, 1999, Heady, 2003) Withdrawals from school reduce probability to return to school (de Janvry et al., 2006) ⇒ lower human capital accumulation ⇒ lower future earnings, productivity, well-being; perpetuated poverty Renate Strobl CBHI in Rwanda: Effective against child labour?
  9. 9. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  10. 10. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Literature Formal health insurance ⇒ Informal risk coping strategies: Dekker and Wilms (2009): insured households sell assets less frequently and borrow less money to finance medical treatment (Uganda) Wagstaff and Pradhan (2005): insured households have higher educational expenditures (Vietnam) Guarcello et al. (2010): children of insured households are less likely to work and more likely to go to school (Guatemala) Renate Strobl CBHI in Rwanda: Effective against child labour?
  11. 11. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Community-based health insurance in Rwanda History: 1999: pilot test in 3 districts, provided by so-called Mutuelles from 2003 on: progressively scaled up to a national system population coverage rate: 7% (2003), 44% (2005), 73% (2006), 91% (2010) Affiliation conditions (time of survey): enrolment at household level annual premium: 2,500-11,500 RWF per household (3.80-17.40 USD) co-payments: 100-150 RWF (0.15-0.22 USD) per visit at health center; 10% of hospital fee at district hospital Benefit Packages: Minimum Package: all services provided at local health center Complementary Package: limited services provided at district hospitals Renate Strobl CBHI in Rwanda: Effective against child labour?
  12. 12. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Community-based health insurance in Rwanda History: 1999: pilot test in 3 districts, provided by so-called Mutuelles from 2003 on: progressively scaled up to a national system population coverage rate: 7% (2003), 44% (2005), 73% (2006), 91% (2010) Affiliation conditions (time of survey): enrolment at household level annual premium: 2,500-11,500 RWF per household (3.80-17.40 USD) co-payments: 100-150 RWF (0.15-0.22 USD) per visit at health center; 10% of hospital fee at district hospital Benefit Packages: Minimum Package: all services provided at local health center Complementary Package: limited services provided at district hospitals Renate Strobl CBHI in Rwanda: Effective against child labour?
  13. 13. Motivation Empirical analyses Discussion and Conclusion Children as insurance asset Formal health insurance Community-based health insurance in Rwanda History: 1999: pilot test in 3 districts, provided by so-called Mutuelles from 2003 on: progressively scaled up to a national system population coverage rate: 7% (2003), 44% (2005), 73% (2006), 91% (2010) Affiliation conditions (time of survey): enrolment at household level annual premium: 2,500-11,500 RWF per household (3.80-17.40 USD) co-payments: 100-150 RWF (0.15-0.22 USD) per visit at health center; 10% of hospital fee at district hospital Benefit Packages: Minimum Package: all services provided at local health center Complementary Package: limited services provided at district hospitals Renate Strobl CBHI in Rwanda: Effective against child labour?
  14. 14. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  15. 15. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Data Data set: Household Living Conditions Survey (EICV2) 2005/06 cross-sectional, nationally representative socio-economic data of 6,900 households and 34,785 individuals community-level data for 440 communities (only for rural part of Rwanda) Final sample: restriction on rural regions of Rwanda exclusion of households insured in health insurance schemes other than Mutuelles (RAMA, MMI, private schemes) households with children from 7-15 years household head older than 15 years ⇒ 5,811 children living in 3,154 households ⇒ 43,4 % of households insured by Mutuelles Renate Strobl CBHI in Rwanda: Effective against child labour?
  16. 16. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Two outcome variables 1 Hours worked: children age 7 - 15 (minimum working age in Rwanda: 16 years) total hours worked in the last 7 days (employment and household chores) 2 Education Gap: Education Gap = max{0, Expected Education −Actual Education} with Expected Education = 0 if age 7 age−7 if 8 age 15 captures any delays (e.g. due to late entry, class repetitions) as well as premature drop-outs Renate Strobl CBHI in Rwanda: Effective against child labour?
  17. 17. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Hours worked Figure 1: Average weekly hours worked, by gender and health insurance status Renate Strobl CBHI in Rwanda: Effective against child labour?
  18. 18. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Education Gap Figure 2: Average Education Gap, by gender and health insurance status Renate Strobl CBHI in Rwanda: Effective against child labour?
  19. 19. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Estimation equation Estimation Equation: Hijk = β0l +β1Xijk +β2Mutuelleijk +ηl +εijk Hijk : Hours worked or Education Gap Mutuelleijk : Mutuelle enrolment (dummy) Xijk : Child, household, community characteristics ηl : District dummies ⇒ Problem: possible endogeneity of Mutuelle enrolment Renate Strobl CBHI in Rwanda: Effective against child labour?
  20. 20. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Estimation equation Estimation Equation: Hijk = β0l +β1Xijk +β2Mutuelleijk +ηl +εijk Hijk : Hours worked or Education Gap Mutuelleijk : Mutuelle enrolment (dummy) Xijk : Child, household, community characteristics ηl : District dummies ⇒ Problem: possible endogeneity of Mutuelle enrolment Renate Strobl CBHI in Rwanda: Effective against child labour?
  21. 21. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Test of endogeneity Two instrumental variables (IV) 1 Community Mutuelle enrolment rate = Ei −Di Ni −1 Ei = Number of enrolled households in community Di = Dummy if household is enrolled Ni = Total number of households in community 2 Satisfaction of household with quality of services provided at district hospital (dummy) Test on relevance and overidentifying restrictions ⇒ IV validated Test of endogeneity ⇒ Mutuelle enrolment can be treated as exogenous ⇒ Simple count data regression models Renate Strobl CBHI in Rwanda: Effective against child labour?
  22. 22. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Test of endogeneity Two instrumental variables (IV) 1 Community Mutuelle enrolment rate = Ei −Di Ni −1 Ei = Number of enrolled households in community Di = Dummy if household is enrolled Ni = Total number of households in community 2 Satisfaction of household with quality of services provided at district hospital (dummy) Test on relevance and overidentifying restrictions ⇒ IV validated Test of endogeneity ⇒ Mutuelle enrolment can be treated as exogenous ⇒ Simple count data regression models Renate Strobl CBHI in Rwanda: Effective against child labour?
  23. 23. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Test of endogeneity Two instrumental variables (IV) 1 Community Mutuelle enrolment rate = Ei −Di Ni −1 Ei = Number of enrolled households in community Di = Dummy if household is enrolled Ni = Total number of households in community 2 Satisfaction of household with quality of services provided at district hospital (dummy) Test on relevance and overidentifying restrictions ⇒ IV validated Test of endogeneity ⇒ Mutuelle enrolment can be treated as exogenous ⇒ Simple count data regression models Renate Strobl CBHI in Rwanda: Effective against child labour?
  24. 24. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  25. 25. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Estimation results: Mutuelle effect Table 1: Count data regression estimates: Average marginal effect of Mutuelle enrolment Hours worked Education Gap (ZINB) (Poisson) n AME (SE) AME (SE) All 5,811 -1.058** (0.475) -0.120*** (0.035) Boys 2,880 -1.491*** (0.573) -0.085* (0.049) Girls 2,931 -0.311 (0.616) -0.168*** (0.045) Standard errors corrected for clustering at the community level; *p < 0.10, **p < 0.05, ***p < 0.01; Control variables: child: sex, age, number of older children in household; household: sex, age, education of head, household size, land owned in acres, distance to primary and secondary school; community: proportion of households with landownings less 2 acres, dummies indicating presence of health center, primary school, market, public telephone. Renate Strobl CBHI in Rwanda: Effective against child labour?
  26. 26. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  27. 27. Motivation Empirical analyses Discussion and Conclusion Empirical strategy Estimation results Robustness check Propensity score matching Table 2: Propensity score matching: Average treatment effect of Mutuelle enrolment Hours worked per child Education Gap per child n ATT (SE) Γ ATT (SE) Γ Radius 3,263 -1.216** (0.437) 1.4 -0.148** (0.059) 1.2 Kernel 3,263 -1.751** (0.673) 1.0 -0.107 (0.070) - Standard errors attained by bootstrapping (50 replications); *p < 0.10, **p < 0.05, ***p < 0.01; Caliper width for radius matching: 0.01; bandwidth for Kernel matching: 0.06; Γ: Sensitivity parameter of Rosenbaum bounds sensitivity analysis; Covariates: sex, age and education of the head, dummy indicating chronical health problems of household members, household size, number of children under 7, number of children in age 7-15, land owned in acres, dummy indicating if the household is houseowner, dummies for consumption quintiles, distance to the nearest health center, district dummies. Renate Strobl CBHI in Rwanda: Effective against child labour?
  28. 28. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  29. 29. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Discussion of results Substantial impact of mutual health insurance on schooling outcomes: remarkably, as Mutuelles cover only a part of total economic cost of illness: do not compensate for lost earnings co-payments have to be effected compared to decrease of child working time of 1 hour per week: suggests that impact on schooling not only via time-liberating effect Renate Strobl CBHI in Rwanda: Effective against child labour?
  30. 30. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Discussion of results Substantial impact of mutual health insurance on schooling outcomes: remarkably, as Mutuelles cover only a part of total economic cost of illness: do not compensate for lost earnings co-payments have to be effected compared to decrease of child working time of 1 hour per week: suggests that impact on schooling not only via time-liberating effect Renate Strobl CBHI in Rwanda: Effective against child labour?
  31. 31. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Possible impact channels Formal health insurance ⇒ Child labour and schooling: 1 Mutuelles protect Rwandan households efficiently against high OOP payments (Lu et al., 2012, Saksena et al. 2011, Shimeles, 2010) ex ante: reduced need to build up a buffer stock ex post: facilitated consumption smoothing 2 Mutuelle members use modern health care more likely (Lu et al., 2012, Saksena et al. 2011, Shimeles, 2010) faster recovery / better overall health status less income losses and treatment costs less time absent in school, better learning performance Renate Strobl CBHI in Rwanda: Effective against child labour?
  32. 32. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Possible impact channels Formal health insurance ⇒ Child labour and schooling: 1 Mutuelles protect Rwandan households efficiently against high OOP payments (Lu et al., 2012, Saksena et al. 2011, Shimeles, 2010) ex ante: reduced need to build up a buffer stock ex post: facilitated consumption smoothing 2 Mutuelle members use modern health care more likely (Lu et al., 2012, Saksena et al. 2011, Shimeles, 2010) faster recovery / better overall health status less income losses and treatment costs less time absent in school, better learning performance Renate Strobl CBHI in Rwanda: Effective against child labour?
  33. 33. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  34. 34. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Policy implications Formal health insurance: Indirect benefits so far unrecognized: crowding out of inefficient risk coping strategies (child labour and school de-enrolment) higher human capital accumulation should be taken into account in cost-efficiency analyses of such policy interventions Useful and necessary complement to explicit child labour countermeasures (bans, compulsory schooling): eliminating child labour without undermining household’s ability to cope with risk Renate Strobl CBHI in Rwanda: Effective against child labour?
  35. 35. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Policy implications Formal health insurance: Indirect benefits so far unrecognized: crowding out of inefficient risk coping strategies (child labour and school de-enrolment) higher human capital accumulation should be taken into account in cost-efficiency analyses of such policy interventions Useful and necessary complement to explicit child labour countermeasures (bans, compulsory schooling): eliminating child labour without undermining household’s ability to cope with risk Renate Strobl CBHI in Rwanda: Effective against child labour?
  36. 36. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Outline 1 Motivation Children as insurance asset Formal health insurance 2 Empirical analyses Empirical strategy Estimation results Robustness check 3 Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Renate Strobl CBHI in Rwanda: Effective against child labour?
  37. 37. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Limitations and Outlook Cross-sectional data set: Unobserved heterogeneity and biasing effect on estimates cannot be definitely ruled out however, solid evidence on robustness of results by using two different evaluation methods Impossible to disentangle impact channels of health insurance (ex post, ex ante, health-related effects) might be important to choose optimal policy intervention (e.g. if ex post consumption smoothing is main driver of results → could also be reached with provision of credits) Renate Strobl CBHI in Rwanda: Effective against child labour?
  38. 38. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Limitations and Outlook Cross-sectional data set: Unobserved heterogeneity and biasing effect on estimates cannot be definitely ruled out however, solid evidence on robustness of results by using two different evaluation methods Impossible to disentangle impact channels of health insurance (ex post, ex ante, health-related effects) might be important to choose optimal policy intervention (e.g. if ex post consumption smoothing is main driver of results → could also be reached with provision of credits) Renate Strobl CBHI in Rwanda: Effective against child labour?
  39. 39. Motivation Empirical analyses Discussion and Conclusion Discussion of results Policy implications Limitations and Outlook Thank you very much for your attention! Renate Strobl CBHI in Rwanda: Effective against child labour?
  40. 40. Appendix References References I Akabayashi, H., Psacharopoulos, G. (1999). The trade-off between child labour and human capital formation: A Tanzanian case study. The Journal of Development Studies, 35(5), 120-140. Beegle, K., Dehejia, R., Gatti, R. (2006). Child labor and agricultural shocks. Journal of Development Economics, 81, 80-96. Beegle, K., Dehejia, R., Gatti, R., Krutikova, S. (2008). The consequences of child labor: Evidence from longitudinal data in rural Tanzania. Policy Research Working Paper No. 4677. Washington, DC.: World Bank. Renate Strobl CBHI in Rwanda: Effective against child labour?
  41. 41. Appendix References References II de Janvry, A., Financ, F., Sadoulet, E., Vakis, R. (2006). Can conditional cash transfer programs serve as safety nets in keeping children at school and from working when exposed to shocks? Journal of Development Economics, 79, 349-373. Dekker, M., Wilms, A. (2009). Health insurance and other risk-coping strategies in Uganda: The case of Microcare Insurance Ltd. World Development, 38(3), 369-378. Fitzsimons, E. (2007). The effects of risk on education in Indonesia. Economic Development and Cultural Change, 56(1), 1-25. Renate Strobl CBHI in Rwanda: Effective against child labour?
  42. 42. Appendix References References III Guarcello, L., Mealli, F., Rosati, F.C. (2010). Household vulnerability and child labor: The effect of shocks, credit rationing, and insurance. Journal of Population Economics, 23, 169-198. Heady, C. (2003). The effect of child labor on learning achievements. World Development, 31(2), 385-398. Jacoby, H.G., Skoufias, E. (1997). Risk, financial markets and human capital in a developing country. Review of Economic Studies, 64, 311-335. Kazianga, H. (2012). Income risk and household schooling decisions in Burkina Faso. World Development, 40(8), 1647-1662. Renate Strobl CBHI in Rwanda: Effective against child labour?
  43. 43. Appendix References References IV Lu, C., Chin,B., Lewandowski, J.L., Basinga, P., Hirschhorn, L.R., Hill, K., Murray, M., Binagwaho, A. (2012). Towards universal health coverage: An evaluation of Rwanda Mutuelles in its first eight years. PloS ONE, 7(6), e39282. O’Donnell, O., Rosati, F.C., van Doorslaer, E. (2005). Health effects of child work: Evidence from rural Vietnam. Journal of Population Economics, 18, 437-467. Saksena, P., Antunes, F.A., Xu, K.Musango, L., Carrin, G. (2011). Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection. Health Policy, 99, 203-209. Renate Strobl CBHI in Rwanda: Effective against child labour?
  44. 44. Appendix References References V Shimeles, A. (2010). Community based health insurance schemes in Africa: The case of Rwanda. African Development Bank Group Working Paper Series. Working Paper No. 120. Tunis: African Development Bank. Wagstaff, A., Pradhan, M. (2005). Health insurance impacts on health and nonmedical consumption in a developing country. World Bank Policy Research Working Paper 3563. Washington, DC.: World Bank. Zabaleta, M.B. (2011). The impact of child labor on schooling outcomes in Nicaragua. Economics of Education Review, 30, 1527-1539. Renate Strobl CBHI in Rwanda: Effective against child labour?

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