Do the more educated utilize more health care services? Evidence from Vietnam using a regression discontinuity design

Abstract

In 1991, Vietnam implemented a compulsory primary schooling reform that provides this study a natural experiment to estimate the causal effect of education on health care utilization with a regression discontinuity design. This paper finds that education causes statistically significant impacts on health care utilization, although the signs of the impacts change with specific types of health care services examined. In particular, education increases the inpatient utilization of the public health sector, but it reduces the outpatient utilization of both the public and private health sectors. The estimates are strongly robust to various windows of the sample choice. The paper also discovers that the links between education and the probability of health insurance and income play essential roles as potential mechanisms to explain the causal impact of education on health care utilization in Vietnam.

Appendices

Appendices

Appendix 1: Definition of variables

Health care utilization outcomes

Public health care services

Probability of an inpatient visit Probability of an inpatient visit to public health care services during the last 12 months ($=1$ if yes, $=0$ otherwise).

Probability of an outpatient visit Probability of an outpatient visit to public health care services during the last 12 months ($=1$ if yes, $=0$ otherwise).

Frequency of inpatient visits The number of inpatient visits to public health care services over the last 12 months (times).

Frequency of outpatient visits The number of outpatient visits to public health care services over the last 12 months (times).

Private health care services

Probability of an inpatient visit Probability of an inpatient visit to private health care services during the last 12 months ($=1$ if yes, $=0$ otherwise).

Probability of an outpatient visit Probability of an outpatient visit to private health care services during the last 12 months ($=1$ if yes, $=0$ otherwise).

Frequency of inpatient visits The number of inpatient visits to private health care services over the last 12 months (times).

Table 8 The impact of the 1991 compulsory schooling reform on the probability of a doctor visit: reduced-form (intent-to-treat) regressions

Frequency of outpatient visits The number of outpatient visits to private health care services over the last 12 months (times).

Main control variables

Male Respondent’s gender is male ($=1$ if yes, $=0$ otherwise).

Urban Respondent’s household is in an urban area ($=1$ if yes, $=0$ otherwise).

Majority Respondent’s ethnicity is the majorities, Kinh or Hoa ($=1$ if yes, $=0$ otherwise).

Red River delta The geographical region is Red River delta ($=1$ if yes, $=0$ otherwise).

Midlands and northern mountainous areas The geographical region is Midlands and northern mountainous areas ($=1$ if yes, $=0$ otherwise).

Northern and coastal central region The geographical region is Northern and coastal central region ($=1$ if yes, $=0$ otherwise).

Table 9 The impact of the 1991 compulsory schooling reform on the frequency of doctor visits: reduced-form (intent-to-treat) regressions

Table 10 The impact of the 1991 compulsory schooling reform on schooling years: robustness, various windows, first-stage

Table 11 The impact of the 1991 compulsory schooling reform on the probability of health insurance and monthly income: Reduce form (intent-to-treat) mechanisms

Central Highlands. The geographical region is Central Highlands ($=1$ if yes, $=0$ otherwise).

Southeastern area. The geographical region is the Southeastern area ($=1$ if yes, $=0$ otherwise).

Mekong river delta. The geographical region is Mekong River delta ($=1$ if yes, $=0$ otherwise).

Fig. 2

The impact of the 1991 compulsory schooling reform on probability of health insurance

Fig. 3

The impact of the 1991 compulsory schooling reform on income

Survey 2010 The survey year is 2010 ($=1$ if yes, $=0$ otherwise).

Survey 2012 The survey year is 2012 ($=1$ if yes, $=0$ otherwise).

Survey 2014 The survey year is 2014 ($=1$ if yes, $=0$ otherwise).

Potential mechanisms

Health insurance The probability of being insured with public or private health insurance ($=1$ if yes, $=0$ otherwise).

Income Respondent’s monthly income (1000 VND, 2010 price).

Schooling variables

Reform exposure Respondent’s probability of being exposed to the 1991 schooling reform that her or his age equals 14 or less than 14 in 1991 ($=1$ if yes, $=0$ otherwise).

Schooling years Respondent’s full schooling years at the year of survey (years).