Aggregation and Insurance-Mortality Estimation

William H. Dow, University of North Carolina at Chapel Hill
Kristy Gonzalez, University of North Carolina at Chapel Hill
Luis Rosero-Bixby, Universidad de Costa Rica

One goal of government health insurance programs is to improve health, yet little is known empirically about how important such government interventions can be in explaining health transitions. We analyze the child mortality effects of a major health insurance expansion in Costa Rica. In contrast to previous work in this area that has used aggregated ecological designs, we exploit census data to estimate individual-level models. Theoretical and empirical findings indicate that aggregation can introduce substantial upward biases in the insurance effects. Overall we find a statistically significant but quite small effect of health insurance on infant mortality in Costa Rica.