Replication Data for: Modest Improvements in Skilled Birth Attendants at Delivery with Increased Mutuelles Coverage

We revisit the question of the role health insurance coverage played in increasing use of Skilled Birth Attendants (SBA) at delivery in Rwanda. Previous studies have suggested that enrollment in Mutuelles health insurance increased the odds of using an SBA by up to 163%. We take advantage of latest Rwanda Demographic Health Survey (RDHS 2010) to increase the sample size and extend the time frame of analysis to five years (2005 to 2010). We also adopt stronger matching methods to control for model dependence. We find that although enrollment in Mutuelles insurance increases use of SBAs at delivery, the size of the effect is orders of magnitude lower than previously published (12 to 18 percent versus 78 to 163 percent). We also find that the effect of education on use of SBA is similar in magnitude and direction as that of Mutuelles insurance enrollment. Our findings lead us to conclude that Mutuelles only had a modest effect on increasing use of SBA at delivery and therefore insurance alone may not be the “magic gullet” that solves the problem of non-use of SBA at delivery.

本研究重新审视了健康保险覆盖在卢旺达提升分娩时专业助产士（Skilled Birth Attendants，SBA）使用率中所发挥的作用这一议题。既往研究显示，参保穆图埃莱斯（Mutuelles）健康保险可使产妇选用专业助产士分娩的发生比提升至多163%。本研究借助最新版《卢旺达人口与健康调查（Rwanda Demographic Health Survey, RDHS 2010）》扩大了样本量，并将分析的时间跨度拓展至5年（2005年至2010年）；同时采用更为严谨的匹配方法以控制模型依赖性。研究结果显示，尽管参保穆图埃莱斯健康保险确实能提升分娩时专业助产士的使用率，但其效应幅度远低于既往发表的研究结果——分别为12%至18%与78%至163%。此外，本研究还发现，受教育程度对产妇选用专业助产士分娩的影响，在效应幅度与作用方向上均与参保穆图埃莱斯健康保险的效果相近。基于上述研究结果，我们得出结论：穆图埃莱斯健康保险对提升分娩时专业助产士使用率仅存在微弱的促进作用，因此仅依靠健康保险或许并非解决助产士分娩使用率低下问题的“万能良方”。