The effect of public health insurance coverage on child health and healthcare utilisation

Public health insurance programs are mainly justified by the aim of reducing inequalities in access to health care, and, in a final instance, improving public health. This goal is particularly important for children because... [ view full abstract ]

Public health insurance programs are mainly justified by the aim of reducing inequalities in access to health care, and, in a final instance, improving public health. This goal is particularly important for children because early health interventions have been shown to be critical for future health and life outcomes. However, while the link between health care utilisation and health insurance has been confirmed by a number of studies, there is less evidence in the literature that increasing eligibility for public insurance actually improves health.

The paper investigates the effect of public health insurance coverage on child health and on their utilisation of health care services in the Republic of Ireland. The greatest challenge with this type of analysis is distinguishing a causal effect of public health insurance from the effect of unobserved heterogeneity, due to, for example, the fact that individuals with greater expected health care use may be more likely to apply for public health insurance and more likely to get it. We account for this issue by using a number of different approaches which include child fixed effect models, difference-in-difference propensity score matching and value added models.

We take advantage of the variety of information from Growing Up in Ireland (GUI) - a nationally representative child cohort study - by focusing on different measures of child health (physical health, psychological well-being) and alternative measures of health care utilisation (visits to the GPs and to hospital Accident and Emergency departments).

Our results show that children whose families benefit from public health insurance coverage have higher healthcare use, but the effects on health are ambiguous. Further research is needed to understand whether this evidence is due to a lower level of health endowment at birth for low-income children, an inefficient utilisation of health care services or other factors.