The impact of private health insurers on the qualit y of regional health care systems in Russia

The 1991 law ‘On health insurance for the citizens of the Russian Federation’ established that social health insurance is to be offered by multiple private insu rance companies. The paper is the first econometric analysis measuring the effect of private health insurers on quality related outcomes of social health insurance (SHI) systems in Russian regions. The baseline model intr oduces regional SHI system as a binary variable wit h unity value corresponding to the presence of private heal th insurers as the only agents at the SHI market. T he extended model captures endogeneity by employing an instrumental variable approach. The non-parametric model us es kernel regressions. The results of parametric and kernel regressions reveal that the presence of private insurers is a s ignificant determinant of infant and under-five mortality. The positive impact of private insurers is explained b y regional institutional reforms. The methods of provider reim bursement are related to infant and under-five mort ality, which offers suggestive evidence for enabling insurer com petition through selective contracting with health care providers.