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Dow Discusses His Research on the Impacts
of an Expansion of a Health Insurance Program on Child Mortality in Costa
Rica
William Dow, Ph.D., Assistant Professor of Health Policy and Administration
at the School of Public Health at the University of North Carolina, Chapel
Hill, discussed his research on the impacts of an expansion of a health
insurance program on child mortality in Costa Rica in a January 14 seminar
co-sponsored by the divisions of Global Health and Health Policy and Administration.
Dow noted that life expectancy in Costa Rica is currently equal to life
expectancy in the United States even though Costa Rica’s per capita
income is only 1/5 as high as the United States’ and Costa Rica’s
per capita health care expenditure is only 1/10 that of the United States’.
These facts have led many to wonder how Costa Rica is able to achieve
good health for its citizens at low cost.
Dow said that there is little data on which health sector reforms are
most likely to improve health. The goal of his research was to identify
the marginal health effect of insurance induced health care increases.
Costa Rica was an ideal place to study because a 1971 law mandated universal
health insurance, and between 1973 and 1980, the percentage of Costa Ricans
with health insurance increased from 40% to approximately 70%.
Dow and his colleagues Kristine Gonzalez and Luis Rosero-Bixby found,
overall, that health insurance had a statistically significant effect
on child mortality in Costa Rica. The effect was concentrated among mothers
with a lower level of education, and mainly occurred outside of Costa
Rica’s capital, San Jose. However, the magnitudes of the estimated
effects were quite small across all population sub-groups.
Dow’s study looked only at child mortality in measuring the impact
of health insurance, and Dow noted that health insurance may have a greater
impact on other health measures. He plans to continue looking at the impact
of the expansion of health insurance programs on child mortality in Taiwan,
South Korea and the United States.
-Story by Christy Gordon
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