International competition and the demand for health insurance in the US: evidence from the Texas-Mexico border region
International competition and the demand for health insurance in the US: evidence from the Texas-Mexico border region
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DOI：
10.1007/s10754-008-9045-z
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发表时间：
2009-03-01
期刊：
影响因子：
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通讯作者：
Bastida, Elena
中科院分区：
文献类型：
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作者：
Brown, H. Shelton, III;Pagan, Jose A.;Bastida, Elena
对没有保险的传统经济学解释应该适用于美国所有的地理区域。然而，加利福尼亚州、亚利桑那州、新墨西哥州和德克萨斯州的未参保率是美国最高的，占美国未参保人口总数的30%以上。我们使用第四波老龄化边境流行病学研究(BESA)的调查数据，这是一项从2005年到2006年在德克萨斯州南部以墨西哥裔美国人为主的地区的调查，以分析美国的医疗保险覆盖范围与墨西哥医疗保健服务的使用之间的关系。BESA包括美国和墨西哥医疗保健服务使用情况的数据。我们估计概率模型，以调查在美国拥有保险和在墨西哥拥有一名正规医生之间的关联，这是感兴趣的独立变量。将私人保险、联邦医疗保险B部分保险和任何类型的公共保险作为因变量来估计不同的模型。我们通过在双变量概率模型中使用工具变量来处理墨西哥正规医生的内生性，这是由于反向因果关系造成的。这些仪器是墨西哥的牙科保健利用情况和经常访问墨西哥的变量测量。结果显示，来自墨西哥的竞争降低了美国一侧的医疗保险覆盖需求。
Conventional economic explanations for uninsurance should apply to all geographic regions in the United States. However, the border states of California, Arizona, New Mexico and Texas have the highest rates of uninsurance in the US, accounting for over 30% of the total US uninsured population. We use survey data from the fourth wave of the Border Epidemiologic Study on Aging (BESA), a survey from a predominantly Mexican American region of South Texas from 2005 to 2006, to analyze how health insurance coverage in the US is related to the use of health care services in Mexico. BESA includes data on the use of health care services in the US and Mexico. We estimate probit models to investigate the association between having insurance coverage in the US and having a regular doctor in Mexico, the independent variable of interest. Separate models are estimated with having private insurance, Medicare Part B insurance, and any type of public insurance as dependent variables. We deal with the endogeneity, due to reverse causality, of having a regular doctor in Mexico by using instrumental variables in a bivariate probit model. The instruments are dental care utilization in Mexico and a variable measuring frequently visiting Mexico. The results show that competition from Mexico lowers the demand for health insurance coverage in the US side of the border.