title: Parental health shocks and schooling: The impact of mutual health insurance in Rwanda.
abstract: The goal of this study was to look at the educational spill-over effects of health insurance on schooling with a focus on the Rwandan Community Based Health Insurance Programme, the Mutual Health Insurance scheme. Using a two-person general equilibrium overlapping generations model, this paper theoretically analyses the possible effect of health insurance on the relationship between parental health shocks and child schooling. Individuals choose whether or not they want to incur a medical cost by seeking care in order to reduce the effect of health shocks on their labour market availability and productivity. The theoretical results show that, health shocks negatively affect schooling irrespective of insurance status. However, if the health shock is severe (incapacitating) or sudden in nature, there is a discernible mitigating effect of health insurance on the negative impact of parental ill health on child schooling. The results are tested empirically using secondary data from the third Integrated Household Living Conditions Survey (EICV) for Rwanda, collected in 2011. A total of 2401 children between the ages of 13 and 18 are used for the analysis. This age group is selected due to the age of compulsory education in Rwanda. Based on average treatment effect on treated we find a statistically significant difference in attendance between children with MHI affiliated parents and those with uninsured parents of about 0.044. The negative effect of a father being severely ill is significant only for uninsured household. For the case of the mother, this effect is felt by female children with uninsured parents only when the illness is sudden. The observed effects are more pronounced for older children. While the father's ill health (sever or sudden) significantly and negatively affects their working hours, health insurance plays appears to increase their working hours. The effects of health insurance extend beyond health outcomes.
authors.affiliation: INSERM, UMR_S 912, «Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale» (SESSTIM), F-13385, Marseille, France; Aix Marseille Université, UMR_S 912, IRD, Marseille, F-13385, Marseille, France; ORS PACA, 23 rue Stanislas Torrents, 13006, Marseille, France. Electronic address: Maame.Woode@lstmed.ac.uk.
authors.forename: Maame Esi
authors.initials: ME
authors.lastname: Woode
mesh_terms: D000293:Adolescent; D002648:Child; D003906:Developing Countries / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006262:Health / Q000592:standards*; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D010290:Parents; D011634:Public Health / Q000379:methods / Q000592:standards; D012044:Regression Analysis; D012432:Rwanda; D012574:Schools / Q000458:organization & administration / Q000706:statistics & numerical data; D066270:Social Capital; D012959:Socioeconomic Factors; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data
keywords: Economic impact; Health shocks; Human capital; Overlapping generations model; Propensity scores; Rwanda; Schooling