Health care facility choice and user free abolition : regression discontinuity in a multinomial choice setting

Abstract

We apply parametric and nonparametric regression discontinuity methodology within a multinomial choice setting to examine the impact of public health care user fee abolition on health facility choice using data from South Africa. The nonparametric model is found to outperform the parametric model both in- and out-of-sample, while also delivering more plausible estimates of the impact of user fee abolition (i.e., the `treatment e ect'). In the parametric framework, treatment e ects were relatively constant { around 10% { and that increase was drawn equally from home care and private care. On the other hand, in the nonparametric framework treatment e ects were largest for large (and poor) families located farther from health facilities { approximately 5%. More plausibly, the positive treatment e ect was drawn primarily from home care, suggesting that the policy favoured children living in poorer conditions, as those children received at least some minimum level of professional health care after the policy was implemented.