Work in progress
Inequities in Health Insurance Enrolment: Evidence from Social Health Protection Initiative in Pakistan
This paper investigates the inequities in social health protection enrolment in the context of the Sehat Sahulat program. We combine the population census data with administrative data on social health protection initiative enrolment as well as combine the administrative data with the rich household panel data. We use non-parametric statistical methods like the Kaplan-Maier survival estimator to determine the time between the effective eligibility and the administrative enrolment of the household. We show descriptively as well as controlling for temporal and spatial differences, that despite the strong pro-poor focus, and intensified enrolment campaigns targeting the poorest population, the enrolment rate of the poorest households is significantly slower compare to less poor households. This is particularly true for non-educated households.
Education and Inequities in Social Health Protection Programs: Evidence from Pakistan (with Andreas Landmann)
This paper investigates the role of education as a possible barrier to the utilization of pro-poor social protection programs. We focus on a large-scale free hospitalization insurance innovation in the province of Khyber Pakhtunkhwa, Pakistan. We are able to combine household panel data including detailed health information as well as household census data with administrative data on insurance enrollment and utilization. We show descriptively as well as controlling for temporal and spatial differences in the enrolment campaign, that education positively correlates with the utilization of the scheme, and that this correlation also exists for female education. Moreover, we explore school construction data as a local schooling supply shocks to instrument for female education and estimate its causal effect on health insurance utilization. We find evidence that female education significantly increases health insurance utilization on the individual as well as household level.
Seven Years Later: Hospital Utilization and Financial Protection under an Established Inpatient Insurance Scheme (wih Simona lHelsmüller)
In recent years, the discourse surrounding health insurance policies in developing nations has gained substantial traction, with a particular focus on how these policies influence healthcare access and financial burdens on households. This paper delves into the relatively unexplored domain of medium-term effects of fully subsidized inpatient health insurance schemes, using the case of Pakistan as a point of study. Building upon earlier findings from household surveys conducted in 2015 and 2017, our research presents novel insights from a 2022 follow-up survey, albeit with a reduced sample. We investigate whether and to what extent the sustained availability of fully subsidized health insurance over a seven-year period influences households' decisions regarding hospitalization, particularly in choosing between private and public healthcare facilities, and how it impacts their out-of-pocket expenditures. This inquiry is situated within a context where such longitudinal analyses are scarce, thereby providing a unique contribution to understanding the longer-term dynamics of health insurance impacts in developing economies.
Published work
Knust Stepanik, V. (2024). Gender dynamics in health decision-making: A study on social health protection utilization in Pakistan. Revue d’économie du développement, 33(3), 59-65.
This paper examines the link between gender dynamics in household health decision-making and the use of the social health protection program in Pakistan. Exclusive female participation in health decisions is associated with increased use of health insurance.
Reports
Electrifying Rural Tanzania. A Grid Extension and Reliability Improvement Intervention. Impact report. (Gunther Bensch, Willem Cornelissen, Jörg Peters, Natascha Wagner, Jan Reichert, Vendula Stepanikova), 2019