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on Health Economics |
| By: | Chiara Orsini; Mauricio Avendano |
| Abstract: | We study whether the relationship between the state unemployment rate at the time of conception and infant health, infant mortality and maternal characteristics in the United States has changed over the years 1980-2004. We use microdata on births and deaths for years 1980-2004 and find that the relationship between the state unemployment rate at the time of conception and infant mortality and birthweight changes over time and is stronger for blacks than whites. For years 1980-1989 increases in the state unemployment rate are associated with a decline in infant mortality among blacks, an effect driven by mortality from gestational development and birth weight, and complications of placenta while in utero. In contrast, state economic conditions are unrelated to black infant mortality in years 1990-2004 and white infant mortality in any period, although effects vary by cause of death. We explore potential mechanisms for our findings and, including mothers younger than 18 in the analysis, uncover evidence of age-related maternal selection in response to the business cycle. In particular, in years 1980-1989 an increase in the unemployment rate at the time of conception is associated with fewer babies born to young mothers. The magnitude and direction of the relationship between business cycles and infant mortality differs by race and period. Age-related selection into motherhood in response to the business cycle is a possible explanation for this changing relationship. |
| JEL: | J1 N0 |
| Date: | 2015–05–14 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:62307&r=hea |
| By: | Kim, Seonghoon (Singapore Management University); Fleisher, Belton M. (Ohio State University); Sun, Jessica Ya (Singapore Management University) |
| Abstract: | We report evidence of long-term adverse health impacts of in utero exposure to malnutrition based on survivors in their 50s who were born during the China Famine that occurred in the years 1959-1961. We take advantage of recently available data provided by the China Health and Retirement Longitudinal Study (CHARLS) to corroborate evidence supporting the Fetal Origin Hypothesis. We find that fetal exposure to malnutrition has large and long-lasting impacts on both physical health and cognitive abilities, including the risks of suffering a stroke, physical disabilities in speech, walking and vision, and measures of mental acuity. Our findings on the health impacts of fetal malnutrition on middle-age survivors suggest that it would be desirable to trace the changes of health status of the famine survivors as they age into later life stages. We suspect that such further study would support the lifetime benefits of in utero and early infancy health interventions that extend through the life cycle in the form of avoiding both physical and mental impairment. |
| Keywords: | fetal origin hypothesis, malnutrition, health, China Famine |
| JEL: | I10 I12 J14 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9093&r=hea |
| By: | Liu, Kai (Norwegian School of Economics) |
| Abstract: | This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investment in children's human capital during negative health shocks, which suggests that one benefit of health insurance could arise from reducing the use of costly smoothing mechanisms. |
| Keywords: | China, health insurance, health shock |
| JEL: | D1 O1 I1 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9094&r=hea |
| By: | Bertocchi, Graziella (University of Modena and Reggio Emilia); Dimico, Arcangelo (Queen's University Belfast) |
| Abstract: | We study the long-term determinants of the high rates of HIV infection in sub-Saharan Africa, particularly among women, with a focus on family structure and sexual behavior as shaped by the demographic shock following the transatlantic slave trade. First we show that, in clusters where polygyny is more widespread, HIV infection rates are higher. By instrumenting polygyny with the demographic shock we can also establish that this link is causal. Next we turn to the channels through which polygyny is likely to affect HIV infection by focusing on sexual behavior, as captured by the intensity of sexual activity and the frequency of extramarital partnerships. We document relevant gender differences in behavior: in clusters affected by a larger demographic shock men (but not women) display a more intense sexual activity, while women (but not men) are more likely to engage in extramarital partnerships. We employ these findings to instrument sexual behavior when estimating its influence on HIV infection and we show that clusters exhibiting more frequent female extramarital partnerships are affected by significantly higher infection rates. We interpret our results as follows. The demographic shock induced by the slave trade represents a "primordial" risk factor which is still shaping contemporary family structure and sexual behavior. Polygyny is associated with unsatisfying marital relationships, particularly for women, with consequent female infidelity and an increased risk of infection, which is further multiplied for women co-habiting within polygynous households. |
| Keywords: | HIV, polygyny, slave trade, sexual behavior |
| JEL: | I15 J12 N37 O10 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9102&r=hea |
| By: | Brian Goesling; Julieta Lugo-Gil; Joanne Lee; Timothy Novak |
| Keywords: | adolescent, evidence-based programs, HIV, sexually transmitted infections, systematic review, teen pregnancy |
| JEL: | I |
| Date: | 2015–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:9c416257fa8143be91c2e0035958b650&r=hea |
| By: | Amy Overcash; Grace Roemer; Angela Gerolamo |
| Keywords: | data gaps, education, Nurses, health |
| JEL: | I C |
| Date: | 2015–05–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:a2b42abee0784b6e8014b15f86fe7ca7&r=hea |
| By: | Brian Goesling; Joanne Lee; Julieta Lugo-Gil; Timothy Novak |
| Abstract: | Since 2009, the U.S. Department of Health and Human Services (HHS) has sponsored an ongoing systematic review of the teen pregnancy prevention research literature to help identify programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections (STIs), and associated sexual risk behaviors. |
| Keywords: | TPP, Teen Pregnancy Prevention, Evidence Review |
| JEL: | I |
| Date: | 2014–07–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:647b4219ffaa4ea4be8c332f75521e0e&r=hea |
| By: | Lorenzo Moreno; Russell Cole |
| Abstract: | This brief provides an overview of how researchers can calculate the minimum detectable impacts (MDIs), which are related to power calculations, for Teen Pregnancy Prevention (TPP) evaluations. It describes a tool that evaluators can use for their own MDI calculations, and includes examples that highlight how to use the tool. A technical appendix provides more details on the formulae in the tool that inform MDI calculations. |
| Keywords: | Minimum Detectable Impacts, TPP, Teen Pregnancy Prevention, Technical Assistance |
| JEL: | I |
| Date: | 2014–12–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:c6286dc5f88f4b45801b441b1a065cd6&r=hea |
| By: | Russell Cole; Seth Chizeck |
| Abstract: | In this brief, we discuss how attrition affects individual- and cluster-level RCTs, how it is assessed, and strategies to limit it. We pay particular attention to meeting the requirements of the current U.S. Department of Health and Human Services (HHS) Evidence Standards for Teen Pregnancy Prevention (TPP) Evaluations. |
| Keywords: | Sample Attrition, TPP, Teenage Pregnancy Prevention, Technical Assistance |
| JEL: | I |
| Date: | 2014–11–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:c41f9bea78e242459fabd62b5013d640&r=hea |
| By: | Miaoqing Yang; Eugenio Zucchelli |
| Abstract: | Recent studies on the effects of anti-smoking policies on subjective well-being present mixed results and focus mainly on smokers. We contribute to the literature by exploiting the policy experiment provided by the UK public smoking bans and evaluating the impact of smoking bans on the subjective well-being of smokers, non-smokers and couples of different types of smokers. We employ matching techniques combined with flexible difference-in-differences fixed effects panel data models on data from the British Household Panel Survey. We find that the UK public smoking bans appear to have a statistically significant short-term positive impact on the well-being of married individuals, especially among couples with dependent children. These effects appear to be substantial in size, robust to alternative specifications and may be driven by positive externalities due to parental altruism. |
| Keywords: | subjective well-being, smoking bans, policy evaluation, BHPS |
| JEL: | C21 C23 I10 I18 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:lan:wpaper:85310008&r=hea |
| By: | Nicholas Apergis (Northumbria University, Newcastle upon Tune, U.K.); Tsangyao Chang (Feng Chia University, Taichung, Taiwan); Christina Christou (University of Piraeus, Piraeus, Greece); Rangan Gupta (Department of Economics, University of Pretoria) |
| Abstract: | Current evidence on the convergence of health care expenditures across the US states into a single convergence club is non-existent. Against this backdrop, we revise this issue using a modified panel unit root test that accounts for smooth structural changes spanning the period of 1966-2009. The results illustrate that the ratio of the individual health care expenditures relative to the cross-sectional average is broken trend-stationary, not only in the aggregate panel, but also across all 50 US states, as indicated by a sequential panel selection method. In addition, the findings also document that the evidence of convergence in health care expenditures is possibly due to the convergence of personal disposable income across the US states. These results are expected to have important policy implications for the US health care market. |
| Keywords: | Health care expenditures, convergence, unit root test, Fourier function, sequential panel selection methodology |
| JEL: | C23 I11 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:pre:wpaper:201542&r=hea |
| By: | Leonardo Becchetti (Università di Roma "Tor Vergata"); Pierluigi Conzo (Università di Torino and CSEF); Francesco Salustri (Università di Roma "Tor Vergata") |
| Abstract: | We investigate the impact of health expenditure on health outcomes on a large sample of Europeans aged above 50 using individual and regional-level data. We find a significant and negative effect of lagged health expenditure on later changes in the number of chronic diseases. This effect varies according to age, health behavior, gender, income and education, thereby supporting the hypothesis that the impact of health expenditure across different interest groups is heterogeneous. Our empirical findings are confirmed also when health expenditure is instrumented with parliament political composition. |
| Keywords: | health satisfaction, education, life satisfaction, public health costs |
| JEL: | I12 I11 I18 |
| Date: | 2015–06–23 |
| URL: | http://d.repec.org/n?u=RePEc:sef:csefwp:406&r=hea |
| By: | Elizabeth Frankenberg; Jessica Y. Ho; Duncan Thomas |
| Abstract: | With populations aging and the epidemic of obesity spreading across the globe, global health risks are shifting toward non-communicable diseases. Innovative biomarker data from recently conducted population-representative surveys in lower, middle and higher income countries are used to describe how four key biological health risks – hypertension, cholesterol, glucose and inflammation – vary with economic development and, within each country, with age, gender and education. As obesity rises in lower income countries, the burden of non-communicable diseases will rise in roughly predictable ways and the costs to society are potentially very large. Investigations that explain cross-country differences in these relationships will have a major impact on advancing understanding of the complex interplay between biology, health and development. |
| JEL: | I15 O10 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21277&r=hea |
| By: | Anne Case; Angus Deaton |
| Abstract: | Suicide rates, life evaluation, and measures of affect are all plausible measures of the mental health and wellbeing of populations. Yet in the settings we examine, correlations between suicide and measured wellbeing are at best inconsistent. Differences in suicides between men and women, between Hispanics, blacks, and whites, between age groups for men, between countries or US states, between calendar years, and between days of the week, do not match differences in life evaluation. By contrast, reports of physical pain are strongly predictive of suicide in many contexts. The prevalence of pain is increasing among middle-aged Americans, and is accompanied by a substantial increase in suicides and deaths from drug and alcohol poisoning. Our measure of pain is now highest in middle age—when life evaluation and positive affect are at a minimum. In the absence of the pain epidemic, suicide and life evaluation are likely unrelated, leaving unresolved whether either one is a useful overall measure of population wellbeing. |
| JEL: | I12 I3 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21279&r=hea |
| By: | Craig Garthwaite; Tal Gross; Matthew J. Notowidigdo |
| Abstract: | American hospitals are required to provide emergency medical care to the uninsured. We use previously confidential hospital financial data to study the resulting uncompensated care, medical care for which no payment is received. We use both panel-data methods and case studies from state-wide Medicaid disenrollments and find that the uncompensated care costs of hospitals increase in response to the size of the uninsured population. The results suggest that each additional uninsured person costs local hospitals $900 each year in uncompensated care. Similarly, the closure of a nearby hospital increases the uncompensated care costs of remaining hospitals. Increases in the uninsured population also lower hospital profit margins, which suggests that hospitals cannot simply pass along all increased costs onto privately insured patients. For-profit hospitals are less affected by these factors, suggesting that non-profit hospitals serve a unique role as part of the social insurance system. |
| JEL: | H51 I11 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21290&r=hea |
| By: | Francesco Decarolis; Maria Polyakova; Stephen P. Ryan |
| Abstract: | The efficiency of publicly-subsidized, privately-provisioned social insurance programs depends on the interaction between insurer behavior and public subsidies. We study this interaction within Medicare Part D Prescription Drug Plan (PDP) markets. Using a structural model of supply and demand, we find: consumers purchase too few and too socially-costly PDP plans; insurers price near marginal cost; the primary driver of welfare is the opportunity cost of government spending on other Medicare programs; and the current subsidization policy achieves a level of total welfare close to that obtained under an optimal in-kind subsidy, but is far from the social planner's first-best solution. |
| JEL: | H2 H4 I11 I18 L1 L2 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21298&r=hea |
| By: | Siqi Zheng; Cong Sun; Matthew E. Kahn |
| Abstract: | Urban China’s high levels of ambient air pollution both lowers quality of life and raises mortality risk. China’s wealthy have the purchasing power to purchase private products such as air filters that allows them to offset some of the pollution exposure risk. Using a unique data set of Internet purchases, we document that households invest more in masks and air filter products when ambient pollution levels exceed key alert thresholds. Richer people are more likely to invest in air filters, which are much more expensive than masks. Our findings have implications for trends in inequality in human capital accumulation and in quality of life inequality in urban China. |
| JEL: | Q53 Q55 R21 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21301&r=hea |
| By: | Mussa, Richard |
| Abstract: | The existing literature on out-of-pocket (OOP) health payments has tended to use binary models to analyse the determinants of catastrophic health spending. In so doing, the literature ignores the fact that shares of out-of-pocket health care payments which are used to define the binary dependent variables are fractional with a mass point at zero. Further to this, the literature makes no distinction between factors which influence the level and the risk of catastrophic health payments. In order to address these shortcomings, this paper departs from this approach, and uses the zero-inflated beta regression instead. The paper also derives elasticity formalae for the zero-inflated beta regression. These elasticities allow one to talk about both the statistical, and economic significance of the different determinants of health nonpayment, catastrophic health spending, and the risk of catastrophe. Data from Malawi's Third Integrated Household survey are used. The empirical results indicate that the same variable can have a different effect on the levels, and risk of catastrophic health spending as well as OOP health nonpayment. |
| Keywords: | Out-of-pocket payments; catastrophic payments; zero-inflated beta; elasticities; Malawi |
| JEL: | I00 |
| Date: | 2015–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:65201&r=hea |
| By: | Mussa, Richard |
| Abstract: | This paper develops distribution-sensitive partial mean effects of determinants of out-of-pocket (OOP) catastrophic health payments. It also proposes methods that can be used to measure how changes in the distribution of the correlates of catastrophic health payments affect the incidence of catastrophic health payments; an inequality effect. The proposed methods are then applied to Malawian data from the Third Integrated Household Survey. The empirical application shows that a failure to account for these inequalities in the correlates, at least normatively, leads to a mismeasurement of the magnitudes of their partial effects. The results also indicate that the signs of the combined effects of a ceteris paribus unit increase in the mean and inequality effects are mixed; for some variables the inequality effect dominates the mean effect while for other variables a reverse pattern is observed. |
| Keywords: | Mean effect; inequality effect; Malawi |
| JEL: | I14 |
| Date: | 2015–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:65203&r=hea |
| By: | Ana María Iregui-Bohórquez (Banco de la República de Colombia); Ligia Alba Melo-Becerra (Banco de la República de Colombia); María Teresa Ramírez-Giraldo (Banco de la República de Colombia) |
| Abstract: | This paper uses the Colombian National Health Survey to analyze the relationship between education and risky health behaviors, namely smoking, heavy drinking, being obese, and unsafe sexual behavior, by estimating the education gradient using Logit models. We also provide evidence on the effect of education, socio-economic and knowledge variables on these health behaviors by gender and area of residence. Results indicate that there is a negative and significant effect of years of schooling on the probability of smoking, whereas the probability of heavy drinking and unsafe sexual behaviors increases with education, highlighting the importance of social and cultural factors. Knowledge variables not only reduce the probability of smoking, but also the probability of heavy drinking and being obese, indicating that campaigns and research on the negative effects of these behaviors have raised awareness about how harmful they are. Classification JEL: I1, I12, I20 |
| Keywords: | Education, risky health behaviors, Colombia |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:bdr:borrec:891&r=hea |
| By: | Schweri, Jürg (Swiss Federal Institute for Vocational Education and Training); Hartog, Joop (University of Amsterdam) |
| Abstract: | As Switzerland experiences a severe shortage of nurses, this paper investigates the impact of students' ex ante wage expectations on their choice to pursue a nursing college education. This analysis contributes to a small yet rapidly developing body of literature that uses subjective expectation data to predict educational choices. We surveyed a full cohort of healthcare trainees in their third year of training. The main result is that those trainees (in upper-secondary education) who expected a greater return from nursing college (tertiary education) were more likely to enroll in nursing college later on. This suggests that policies that increase returns from studying nursing can attract students to nursing. In addition, the results confirm that subjective wage expectation data are useful in modeling individual choice. |
| Keywords: | college choice, fractional regression, healthcare, human capital, nursing, subjective expectations, training, wage |
| JEL: | I11 I21 J24 J31 D84 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9120&r=hea |
| By: | David Iselin (KOF Swiss Economic Institute, ETH Zurich, Switzerland); Matthias Bannert (KOF Swiss Economic Institute, ETH Zurich, Switzerland) |
| Abstract: | In most developed countries drugs are dispensed to patients through physicians and pharmacists. This paper studies the effects of allowing doctors to directly dispense drugs to patients (self-dispensation) on pharmaceutical coverage. We use a Swiss dataset in our empirical analysis because Switzerland's federalist legislation allows us to study self-dispensing and non-self-dispensing regimes alike. We add location information obtained from Google Geocoding services to our dataset in order to measure coverage based on distances. To capture a driver of long term positioning decisions, we take revenues as a proxy for a pharmacy's usage rate. We find that, ceteris paribus, self-dispensation leads to a lowered regional density of pharmacies. By matching similar pharmacies across both regimes we find that revenues are substantially lower for pharmacies under a self-dispensation regime. Pharmacies in cantons that allow physicians to dispense drugs tend to have relatively higher revenues associated with non-drugs. We suggest to organize legislation on self-dispensation at a fine grained regional level as regional typologies are the most reasonable justication for regime choice. |
| Keywords: | pharmaceutical coverage, drug dispensation, self-dispensation, health care expenditures, GIS, Propensity Score Matching |
| JEL: | I18 I11 C21 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:kof:wpskof:15-387&r=hea |
| By: | McHugh, Neil (Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK); Biosca, Olga (Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK); Donaldson, Cam (Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK) |
| Abstract: | Background There is a growing need to identify upstream public health interventions as an alternative means of acting on health. Microfinance has been portrayed in this regard in public health journals. Furthermore, microfinance has spread to more-advanced economies where it offers potential as an alternative means of acting on persistent and growing health inequalities. However recent considerations establish that randomised controlled trials (RCTs) represent the ‘gold standard’ in impact evaluation of microcredit. Discussion In seeking to evidence ‘microcredit as a public health initiative’ in a Western context we question the notion of trials as the apparent gold standard for microcredit evaluations by comparing this approach to developments in thinking about study design for complex public health interventions. This field has moved onto a more eclectic approach to study design for complex interventions with recognition given to insights drawn from non-randomised study designs and qualitative studies. Furthermore, we consider ethical issues currently missing from the global debate on impact assessment, raised by the notion of mounting microcredit RCTs in Western contexts. These issues relate to equipoise and the screening devices used for randomisation and raise the question of whether it would ethically be possible to conduct a microcredit RCT in a Western context. Summary RCTs represent an attempt to improve the internal validity of microfinance impact evaluations. However, questions remain regarding the appropriateness of adopting this method to the exclusion of other important sources of evidence. Thus while microfinance may hold potential in the field of public health, the sector may first have to heed methodological lessons from public health to enhance its evidence base. |
| Keywords: | 2015-01 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:yun:hewpse:201501&r=hea |
| By: | Kundu, Nobinkhor |
| Abstract: | The objective of this paper is to examine the stability of the under-five mortality child mortality hypothesis for Bangladesh over the period 1981 to 2013. However, due to Growth of female literacy rate and per capita gross national income does help reduce child mortality in the Bangladesh, and shows the stable relationship between them can change over time. Over the last decades across states a can be attributed to achieve the Millennium Development Goals for target reducing the under-5 mortality by two-thirds of Bangladesh. Using the time-series data, 1981-2013 period, and applying unit root test and Chow test. Using the Chow test, the paper finds that the child mortality function does not maintain stability between pre and post-MDG period. The finding of the study has strong implication in appropriate policy responses need to recognize that a given level of growth is consistent with different rates of child mortality reduction to achieve basic demographic goals in Bangladesh. |
| Keywords: | Child Mortality, Millennium development goal, Structural Stability |
| JEL: | C62 I18 J11 |
| Date: | 2014–09–18 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:65241&r=hea |
| By: | Zhang, Yanjie; Glauben, Thomas |
| Abstract: | Uncorrected vision is prevalent among rural children and those who migrate from rural areas to urban areas with their parents in China, of which more than 20 per cent are nearsighted. Since 2012 the Rural Education Action Program (REAP) has carried out the largest empirical vision care project ever conducted in China. More than 20,000 children in different parts of China have been screened and about 5,000 pairs of eyeglasses have been dispensed to those who are nearsighted. REAP has been able to create a comprehensive picture of vision care for rural and migrant children in China. The successfully implemented project so far has provided valuable lessons for treating vision problems. First, wearing eyeglasses can remarkably improve children's educational performance and self-confidence. Second, in contrast to widespread opinion in rural China, eyeglasses are by no means harmful to children's eyesight. Third, and in contrast to another myth, specific 'eye exercises' used as a traditional alternative to eyeglasses cannot slow the onset or progression of myopia. Finally, teacher incentives to encourage children to wear eyeglasses will improve rates of eyeglasses usage, help to overcome vision problems and thus lower educational barriers. Based on these findings, researchers of the project are currently working with local governments in rural China to incorporate vision care into the healthcare agenda. |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:iamopb:23&r=hea |
| By: | Das,Jishnu; Holla,Alaka; Mohpal,Aakash; Muralidharan,Karthik |
| Abstract: | This paper presents direct evidence on the quality of health care in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. Three main findings are reported. First, private providers are mostly unqualified, but they spent more time with patients and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, the private practices of qualified public sector doctors were identified and the same doctors exerted higher effort and were more likely to provide correct treatment in their private practices. Third, there is a strong positive correlation between provider effort and prices charged in the private sector, whereas there is no correlation between effort and wages in the public sector. The results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low both sectors, the differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare. |
| Keywords: | Gender and Health,Disease Control&Prevention,Health Systems Development&Reform,Health Monitoring&Evaluation,Markets and Market Access |
| Date: | 2015–06–23 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:7334&r=hea |