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on Health Economics |
| By: | Harris, Matthew; Kessler, Lawrence; Murray, Matthew; Glenn, Beth |
| Abstract: | We examine the effect of prescription opioids on county labor market outcomes, using data from the Prescription Drug Monitoring Programs of ten U.S. states and labor data from the Bureau of Labor Statistics. We achieve causal identofication by exploiting plausibly exogenous variation in the concentration of high-volume prescribers as instruments (using Medicare Part D prescriber data). We find strong adverse effects on labor force participation rates, employment- to-population ratios, and unemployment rates. Notably, a 10 percent increase in prescriptions causes a 0.56 percentage point reduction in labor force participation, similar to the drop attributed to the 1984 liberalization of Disability Insurance. |
| Keywords: | I12, J21 |
| JEL: | I12 J21 |
| Date: | 2017–10–07 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:86586&r=hea |
| By: | Amanda E. Kowalski (Cowles Foundation, Yale University) |
| Abstract: | I aim to shed light on why emergency room (ER) utilization increased following the Oregon Health Insurance Experiment but decreased following a Massachusetts policy. To do so, I unite the literatures on insurance and treatment e?ects. Under an MTE model that assumes no more than the LATE assumptions, comparisons across always takers, compliers, and never takers can inform the impact of polices that expand and contract coverage. Starting from the Oregon experiment as the “gold standard,” I make comparisons within Oregon and extrapolate my ?ndings to Massachusetts. Within Oregon, I ?nd adverse selection and heterogeneous moral hazard. Although previous enrollees increased their ER utilization, evidence suggests that subsequent enrollees will be healthier, and they will decrease their ER utilization. Accordingly, I can reconcile the Oregon and Massachusetts results because the Massachusetts policy expanded coverage from a higher baseline, and new enrollees reported better health. |
| Keywords: | Compliers, Marginal treatment effect, Massachusetts health reform, Program evaluation, Treated outcome test, Untreated outcome test |
| JEL: | C1 C9 H4 I13 |
| Date: | 2018–06 |
| URL: | http://d.repec.org/n?u=RePEc:cwl:cwldpp:2135&r=hea |
| By: | Gravelle, Hugh S; Liu, Dan; Propper, Carol; Santos, Rita |
| Abstract: | We examine whether family doctor firms in England respond to local competition by increasing their quality. We measure quality in terms of clinical performance and patient-reported satisfaction to capture its multi-dimensional nature. We use a panel covering 8 years for over 8000 English general practices, allowing us to control for unobserved local area effects. We measure competition by the number of rival doctors within a small distance. We find that increases in local competition are associated with increases in clinical quality and patient satisfaction, particularly for firms with lower quality. However, the magnitude of the effect is small. |
| Keywords: | Quality; healthcare; choice; competition; family physicians |
| JEL: | I11 I18 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:12917&r=hea |
| By: | Charles Bellemare (Laval University); Marion Goussé (Laval University); Guy Lacroix (Laval University); Steeve Marchand (Laval University) |
| Abstract: | We investigate the determinants and extent of labor market discrimination toward people with physical disabilities using a large scale field experiment. Applications were randomly sent to 1477 private firms advertising open positions. We find that average callback rates of disabled and non-disabled applicants are respectively 14.4% and 7.2%. We find this differential does not result from accessibility constraints related to firm infrastructures. We also find that mentioning eligibility to a government subsidy to cover the cost of workplace adaptation does not increase callback rates. Finally, we estimate that a lower bound of the proportion of discriminating firms is 49.7%. |
| Keywords: | discrimination, disability, partial identification |
| JEL: | J71 J68 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2018-027&r=hea |
| By: | Jarl, Johan (Department of Clinical Sciences, Lund University); Linder, Anna (Department of Clinical Sciences, Lund University); Busch, Hillevi (The Public Health Agency of Sweden); Nyberg , Anja (Department of Healthcare Management, Region Skåne); Gerdtham, Ulf-G. (Department of Economics, Lund University) |
| Abstract: | The burden of mental disorders continues to grow and is now a leading cause of disability worldwide. The prevalence of mental disorders is unequal between population subgroups, and these disorders are associated with unfavourable consequences in social and economic conditions, health and survival. However, how the negative effects of mental disorders are distributed among population subgroups is less studied. Our aim is to investigate how labour market consequences of Common Mental Disorders (CMD) differ over gender, age, education, and country of birth. We use a population sample from southern Sweden of patients diagnosed with CMD 2009-2012 and a matched general population control group with linked register information on employment, long-term sick leave, and disability pension. Logistic regression with interaction effects between CMD and sociodemographic indicators are used to estimate labour market consequences of CMD in the different population subgroups. CMD have a negative impact on all labour market outcomes studied, reducing employment while increasing the risk of long term sick leave and disability pension. However, the associated effect is found to be stronger for men than women, except for disability pension where consequences are similar. Surprisingly, high educated individuals suffer worse labour market consequences than low educated. Consequences of CMD in labour market outcomes are not consistent across different age-groups and country of birth. Inequalities in the labour market consequences of common mental disorders sometimes contributes to, and sometimes mitigates, societal inequalities in employment, long term sick leave and disability pension. When developing new strategies to tackle mental ill health in the population, it may therefore be motivated to consider not only inequalities in the prevalence of mental disorders, but also inequalities in the consequences of these disorders. |
| Keywords: | Mental health; Inequality; Employment; Labour market |
| JEL: | I10 I14 J01 |
| Date: | 2018–06–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2018_015&r=hea |
| By: | Sebastian Vollmer (Goerg-August-Universität Göttingen, Germany); Juditha Wójcik (Johannes Gutenberg-University Mainz, Germany) |
| Abstract: | Several country-level studies, including a prominent one for the United States, have identified long-term effects of in-utero exposure to the 1918 influenza pandemic (also known as the Spanish Flu) on economic outcomes in adulthood. In-utero conditions are theoretically linked to adult health and socioeconomic status through the fetal origins or Barker hypothesis. Historical exposure to the Spanish Flu provides a natural experiment to test this hypothesis. Although the Spanish Flu was a global phenomenon, with around 500 million people infected worldwide, there exists no comprehensive global study on its long-term economic effects. We attempt to close this gap by systematically analyzing 117 Census data sets provided by IPUMS International. We do not find consistent global long-term effects of influenza exposure on education, employment and disability outcomes. A series of robustness checks does not alter this conclusion. Our findings indicate that the existing evidence on long-term economic effects of the Spanish Flu is likely a consequence of publication bias. |
| Keywords: | Spanish Flu; 1918 Influenza Pandemic; Fetal Origins Hypothesis |
| JEL: | I15 N30 O57 |
| Date: | 2017–12–06 |
| URL: | http://d.repec.org/n?u=RePEc:jgu:wpaper:1721&r=hea |
| By: | Judith Bom (Erasmus University Rotterdam); Pieter Bakx (Erasmus University Rotterdam); Erik Schut (Erasmus University Rotterdam); Eddy (E.K.A.) van Doorslaer (Erasmus University Rotterdam) |
| Abstract: | Informal caregiving is a potentially attractive alternative to formal care but may entail health costs for the caregiver. We examine the mental and physical health impact of providing informal care and disentangle the caregiving effect – the effect of caring for someone in need – from the family effect – the effect of caring about someone in need. We account for potential endogeneity in the caregiving decision and control for previous health status using Arellano-Bond difference GMM models. We use four waves (2010-2013) of panel data from the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM). We find that caregiving harms the mental health of caregivers; this effect is mainly present for spousal caregivers. A negative health shock of a family member also has a direct negative effect on mental health, providing evidence of a family effect. These findings imply that most studies may have overestimated the negative health effects of caregiving by not accounting adequately for the family effect. As the caregiving effect differs strongly between various types of caregivers, policies to counteract this effect should specifically target subgroups of caregivers that carry the largest burden of informal caregiving. |
| Keywords: | long-term care; informal care; caregiver effect; family effect; mental health |
| JEL: | J14 I10 J18 |
| Date: | 2018–05–18 |
| URL: | http://d.repec.org/n?u=RePEc:tin:wpaper:20180050&r=hea |
| By: | Howley, P.;; Moro, M.;; Waqas, M.;; Delaney, L.;; Heron, T.; |
| Abstract: | Medical liability systems have been accused of increasing health expenditure insofar as they induce the practice of defensive medicine. Despite the large evidence on the role of medical malpractice liability, the identification of its causal effect on physicians’ treatment decisions is a difficult task. In this paper we study for the first time in a controlled laboratory setting the effect of introducing the risk of being sued for medical malpractice on the provision of physicians’ medical services. In our experimental sessions both medical and non-medical students choose how many medical services to provide for heterogeneous patients. We implement exogenous variations in the presence of medical malpractice liability and expected probability of being sued, and thus we exploit the within-subject variation in the provision of medical services to infer the causal effect of malpractice liability. Furthermore, we analyze the impact of malpractice liability under different physicians’ payment methods, which allows us to discuss the interplay between medical liability and payment systems. Our behavioral data show that introducing malpractice liability pressure does lead physicians to choose a higher amount of medical services, regardless of the physicians’ payment system. However, we also find that the payment system in which malpractice liability is implemented makes the difference under the societal perspective, with relevant implications for health policy. |
| Keywords: | immigration; subjective well-being; UK; Brexit; |
| JEL: | J61 I31 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:18/12&r=hea |
| By: | Sara Rellstab (Erasmus University Rotterdam); Pieter Bakx (Erasmus University Rotterdam); Pilar (P.) Garcia-Gomez (Erasmus University Rotterdam); Eddy (E.K.A.) van Doorslaer (Erasmus University Rotterdam) |
| Abstract: | Unexpected negative health shocks may have serious consequences for labour force participation, not only for those who incur the shock but also for their family members. In particular, adult children may spend substantial time providing informal care and may incur stress-induced mental health problems following a parental health shock, which may in turn lead to reductions in labour supply. We link administrative data on labour market outcomes, hospitalisations and family relations for the full Dutch population for the years 1999-2008 to evaluate the effect of an unexpected parental hospitalisation on the probability of employment and on conditional earnings for the working age population. Using a difference-in-differences model combined with coarsened exact matching and individual fixed effects, we find no effect of an unexpected parental hospitalisation on either the probability of employment or conditional earnings for Dutch men and women, and neither for the full population nor for subpopulations most likely to become a caregiver. These findings suggest that the extensive public coverage of formal long-term care in the Netherlands provides sufficient opportunities to deal with adverse health events of family members without having to compromise one’s labour supply. |
| Keywords: | Labour supply; parental health shocks; informal care |
| JEL: | J22 J14 J10 I10 |
| Date: | 2018–05–18 |
| URL: | http://d.repec.org/n?u=RePEc:tin:wpaper:20180049&r=hea |
| By: | Castro, M.F.;; Ferrara, P.;; Guccio, C.;; Lisi, D.; |
| Abstract: | Medical liability systems have been accused of increasing health expenditure insofar as they induce the practice of defensive medicine. Despite the large evidence on the role of medical malpractice liability, the identification of its causal effect on physicians’ treatment decisions is a difficult task. In this paper we study for the first time in a controlled laboratory setting the effect of introducing the risk of being sued for medical malpractice on the provision of physicians’ medical services. In our experimental sessions both medical and non-medical students choose how many medical services to provide for heterogeneous patients. We implement exogenous variations in the presence of medical malpractice liability and expected probability of being sued, and thus we exploit the within-subject variation in the provision of medical services to infer the causal effect of malpractice liability. Furthermore, we analyze the impact of malpractice liability under different physicians’ payment methods, which allows us to discuss the interplay between medical liability and payment systems. Our behavioral data show that introducing malpractice liability pressure does lead physicians to choose a higher amount of medical services, regardless of the physicians’ payment system. However, we also find that the payment system in which malpractice liability is implemented makes the difference under the societal perspective, with relevant implications for health policy. |
| Keywords: | medical liability; defensive medicine; payment systems; physicians’behavior; laboratory experiment; |
| JEL: | I12 K13 C91 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:18/11&r=hea |
| By: | Marius Huguet (Univ Lyon, Université Lumière Lyon 2, GATE UMR 5824, F-69130 Ecully, France); Xavier Joutard (Aix Marseille Univ, CNRS, LEST, Aix-en-Provence; OFCE, sciences Po, Paris); Isabelle Ray-Coquart (Univ Lyon, Université Claude Bernard Lyon 1, Centre Léon Bérard, EA7425 HESPER, F-69008 Lyon, France); Lionel Perrier (Univ Lyon, Université Lumière Lyon 2, Centre Léon Bérard, GATE UMR 5824, F-69008 Lyon, France) |
| Abstract: | Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients’ homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies. |
| Keywords: | Volume outcome relationship, France, Epithelial Ovarian Cancer, Instrumental variable, Organization of care, Care pathway, Learning effect, Centralization of care |
| JEL: | C31 C36 I11 I18 L11 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:gat:wpaper:1809&r=hea |
| By: | Canta, Chiara; Cremer, Helmuth |
| Abstract: | We study the design of public long-term care (LTC) insurance when the altruism of informal caregivers is uncertain. We consider non-linear policies where the LTC benefit depends on the level of informal care, which is assumed to be observable while children's altruism is not. The traditional topping up and opting out policies are special cases of ours. Both total and informal care should increase with the children's level of altruism. This obtains under full and asymmetric information. Social LTC, on the other hand, may be non-monotonic. Under asymmetric information, social LTC is lower than its full information level for the lowest level of altruism, while it is distorted upward for the higher level of altruism. This is explained by the need to provide incentives to highaltruism children. The implementing contract is always such that social care increases with formal care. |
| Keywords: | Long term care; uncertain altruism; private insurance; public insurance; topping up; opting out |
| JEL: | H2 H5 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:ide:wpaper:32683&r=hea |
| By: | Sonja C. Kassenboehmer (Monash University); Stefanie Schurer (The University of Sydney) |
| Abstract: | We develop and test an economic model of the cognitive and non-cognitive foundations of survey item- response behavior. We show that a summary measure of response behaviour – the survey item-response rate (SIRR) – varies with cognitive and less so with non-cognitive abilities, has a strong individual fixed component and is predictive of economic outcomes because of its relationship with ability. We demonstrate the usefulness of SIRR, although an imperfect proxy for cognitive ability, to reduce omitted-variable biases in estimated wage returns. We derive both necessary and sufficient conditions under which the use of an imperfect proxy reduces such biases, providing a general guideline for researchers. |
| Keywords: | survey item-response behavior, imperfect proxy variables, behavioral proxy, cognitive ability, personality traits, selection on unobservables |
| JEL: | J24 C18 C83 I20 J30 |
| Date: | 2018–06 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2018-035&r=hea |
| By: | Giuliano Masiero (Department of Engineering, University of Bergamo, Italy; Institute of Economics (IdEP), Università della Svizzera italiana, Switzerland); Fabrizio Mazzonna (Institute of Economics (IdEP), Università della Svizzera italiana, Switzerland; Munich Center for the Economics of Aging (MEA), Germany); Olaf Verbeek (Institute of Economics (IdEP), Università della Svizzera italiana, Switzerland) |
| Abstract: | Antidepressant (AD) consumption has been steadily increasing in the last decade in most countries. The explanations suggested by researchers for this increment are still under scrutiny. This study attempts to identify the determinants of AD consumption by exploiting small area variations from Switzerland between 2003 and 2014. We observe that two specific drugs - Citalopram and Escitalopram - within the Selective Serotonin Re-uptake Inhibitors (SSRI) category are mainly responsible for the increasing trend in AD consumption. Socio-economic, demographic, cultural, and geographical characteristics of the area are included in multiple regression models with random and fixed effects of AD consumption per capita. While most of these factors contribute to explain cross-area variations in AD use, they provide little explanation for the temporal trend in overall AD consumption. Conversely, we find that the time trend in AD consumption is explained at least partially by the density of prescribing physicians. More precisely, generic AD turn out to be positively associated with adverse local economic conditions, while branded AD are negatively associated with adverse economic conditions and positively related to the presence of neurologists and psychiatrists in the area. This may suggest that generic AD drugs are more likely prescribed in accordance to need, whereas branded AD are more likely to respond to preferences and financial incentives affecting suppliers. |
| Keywords: | Antidepressant Consumption, Healthcare Demand, Socio-economic Determinants |
| JEL: | C13 I11 I18 |
| Date: | 2018–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:lug:wpidep:1801&r=hea |
| By: | David Mesa-Ruiz (U. Pablo de Olavide); Yolanda Rebollo-Sanz (U. Pablo de Olavide); Jesús Rodríguez-López (U. Pablo de Olavide) |
| Abstract: | This paper presents an assessment of the external cost of drunk driving in Spain between 2004-2015. Eventually we arrive at the following conclusions. Firstly, we find the relative risk of drunk drivers causing a crash during the night (20:00 p.m. to 5:00 a.m.) to be between 2.7 to 3.9 times higher than that of sober drivers. Secondly, we provide evidence that the relative number of drunk drivers versus sober drivers declined during nighttime hours after the implementation of the Penalty Points System for driving licenses in Spain on July 1st 2006. Thirdly, using logistic and count model regressions, we confirm hourly heterogeneity in the pattern of drunk driving, and estimate elasticities of fatal crashes with respect to drunk driving, which range between 0.5 and 0.7. When estimating the decline in fatalities after the Penalty Points System, our approach does a good job in capturing the change in fatalities during nighttime hours that can be accounted for by drunk driving. Finally, our assessment indicates a downturn in the external costs of drunk driving over the last decade in Spain. In addition, we estimate that the fine for drunk driving should be set at 1250€, in order to offset its external costs. Overall, our results point to a decline in drunk driving offences alongside an increase in its punition. |
| Keywords: | Road accidents, drunk driving, relative risk, multinomial probability, negative binomial, external costs. |
| JEL: | R49 E32 C22 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:pab:wpaper:18.07&r=hea |
| By: | Jack Gettens; Pei-Pei Lei; Alexis Henry |
| Abstract: | There is wide geographic variation in Social Security Disability Insurance and Supplementary Security Income participation across the United States. |
| Keywords: | Geographic Variation, SSI, SSDI, Employment |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:34e9e46c5c5f4742a808f545dbfdd2c9&r=hea |
| By: | Ben-David, Itzhak (Ohio State University); Bos, Marieke (Swedish House of Finance) |
| Abstract: | Increased availability of temptation goods might harm individuals if they have time-inconsistent preferences and consume more in the present than planned before. We study this idea by examining the credit behavior of low-income households around the expansion of the opening hours of retail liquor stores during a nationwide experiment in Sweden. Consistent with store closures serving as commitment devices, expanded operating hours led to higher alcohol consumption (Nordstrom and Skog 2003) and greater consumer credit uptake and default. Thus, our results show that limiting the availability of temptation goods can improve the financial wellbeing of individuals with inconsistent-time preferences. |
| JEL: | D03 D12 I18 L51 L66 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:ohidic:2017-06&r=hea |
| By: | Jeremy Edwards; Sheilagh Ogilvie |
| Abstract: | Voigtländer and Voth argue that the Black Death shifted England towards pastoral agriculture, increasing wages for unmarried women, thereby delaying female marriage, lowering fertility, and unleashing economic growth. We show that this argument does not hold. Its crucial assumption is inconsistent with the evidence: women wanting to do pastoral work after the Black Death did not have to remain unmarried, so improved pastoral opportunities did not necessitate later marriage. There is no consensus that late female marriage emerged after the Black Death. Furthermore, the relationship between pastoralism and female marriage age in England provides no support for this argument. |
| Keywords: | European marriage pattern, black death, land-labour ratio, arable and pastoral agriculture |
| JEL: | E02 J12 J13 N13 N33 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_7016&r=hea |
| By: | Crosetto, P.; Lacroix, A.; Muller, L.; Ruffieux, B. |
| Keywords: | NUTRITIONAL LABELS;EXPERIMENT;FRONT-OF-PACK |
| JEL: | C93 Q18 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:gbl:wpaper:2018-11&r=hea |
| By: | Prados de la Escosura, Leandro |
| Abstract: | This paper provides a long-run view of well-being inequality at world scale based on a new historical dataset. Trends in social dimensions alter the view on inequality derived from per capita GDP. While in terms of income, inequality increased until the third quarter of the twentieth century; in terms of well-being, inequality fell steadily since World War I. The spread of mass primary education and the health transitions were its main drivers. The gap between the West and the Rest explains only partially the evolution of well-being inequality, as the dispersion within the developing regions has increasingly determined its evolution. |
| Keywords: | education; Health Transition; inequality; Life Expectancy; per capita GDP; Well-being |
| JEL: | I00 N30 O15 O50 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:12920&r=hea |
| By: | J. Guan; JdD Tena |
| Abstract: | This study investigates the causal impact of acquiring social medical Insurance on hospital utilisation and health status for children under 16 years old in China from 2010 to 2016. We consider the China Family Panel Studies (CFPS), a longitudinal database which allows us to control for the effect of unobserved individual heterogeneity by means of difference-in-difference regressions combined with matching regression techniques. Our findings suggest that participating in social medical insurance schemes significantly increases children's yearly hospital use, especially for children who come from rural China. Moreover, this increase is not significantly different for people who were not previously sick. It is also found that social medical insurance schemes have no effect or even a marginally negative effect on children's health status in some cases. We discuss some potential explanations for this result. |
| Keywords: | China;Social Medical Insurance;Health Outcomes;difference-in-difference;propensity score matching |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:cns:cnscwp:201807&r=hea |
| By: | Marion Krämer (Department of Economics, University of Goettingen, Germany); Santosh Kumar (Department of Economics and International Business, Sam Houston State University); Sebastian Vollmer (Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Germany) |
| Abstract: | We present experimental evidence on the impact of delivering double-fortified salt (DFS), salt fortified with iron and iodine, through the Indian school-feeding program called “mid-day meal” on anemia, cognition, and math and reading outcomes of primary school children. We conducted a field experiment that randomly provided a one-year supply of DFS at a subsidized price to public primary schools in one of the poorest regions of India. The DFS treatment had significantly positive impacts on hemoglobin levels and reduced the prevalence of any form of anemia by 20 percent but these health gains did not translate into statistically significant impacts on cognition and test scores. While exploring the heterogeneity in effects, we find that treatment had statistically significant gains in anemia and test scores among children with higher treatment compliance. We further estimate that the intervention was very cost effective and can potentially be scaled up rather easily. |
| Keywords: | Double-fortified salt, education, anemia, school feeding, India, and randomized controlled trial |
| JEL: | C93 I15 O11 |
| Date: | 2018–06 |
| URL: | http://d.repec.org/n?u=RePEc:shs:wpaper:1803&r=hea |
| By: | Nicky Pouw (University of Amsterdam, NL); Barbara Rohregger; Esther Schüring; Kennedy Alatinga; Bethuel Kinuthia; Katja Bender |
| Abstract: | This paper analyzes the complex effects and risks of social protection programmes in Ghana and Kenya on poor people’s human wellbeing, voice and empowerment and interactions with the social protection regulatory framework and policy instruments. For this purpose, it adopts a comprehensive Inclusive Development framework to systematically explore the complex effects of cash transfers and health insurance at the individual, household and community level. The findings highlight the positive provisionary and preventive effects of social protection, but also illustrate that the poorest are still excluded and that promotive effects, in the form of enhanced productivity, manifest themselves mainly for the people who are less resource poor. They can build more effectively upon an existing asset base, capabilities, power and social relations to counter the exclusionary mechanisms of the system, address inequity concerns and offset the transaction costs of accessing and benefitting from social protection. The inclusive development framework enables to lay these complex effects and interactions bear, and points to areas that require more longitudinal and mixed methodology research. |
| Keywords: | social protection, inclusive development, Ghana, Kenya, human wellbeing, transformative effects |
| JEL: | I38 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:sau:iznews:1803&r=hea |
| By: | James Berry; Greg Fischer; Raymond Guiteras |
| Abstract: | Using the Becker-DeGroot-Marschak (BDM) mechanism, we estimate the willingness-to-pay (WTP) for and impact of clean water technology through a field experiment in Ghana. Although WTP is low relative to the cost, demand is relatively inelastic at low prices. In the short-run, treatment effects are positive—the incidence of children's diarrhea falls by one third—and consistent throughout the WTP distribution. After a year, usage has fallen, particularly for those with relatively low valuations. Strikingly, the long-run average treatment effect is negative for those with valuations below the median. Combining estimated treatment effects with individual willingness-to pay measures implies households' valuations of health benefits are much smaller than those typically used by policymakers. Finally, we explore differences between BDM and take-it-or-leave-it valuations and make recommendations for effectively implementing BDM in the field. |
| Keywords: | price mechanism, heterogeneous treatment effects, health behaviour, Becker-DeGroot-Marschak, field experiments |
| JEL: | C26 C93 D12 L11 L31 O12 Q51 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:cep:stieop:066&r=hea |
| By: | Schleicher, Michael; Klonner, Stefan; Sauerborn, Rainer; Sié, Alie; Souares, Aurélia |
| Abstract: | We investigate the properties of health insurance demand in Burkina Faso, where we offered poor households a voluntary health insurance product at half the usual price. The targeting procedure we implemented delivers a fuzzy regression discontinuity design, which identifies the price elasticity of demand for health insurance as well as associated selection effects. We find large price elasticities among urban households, whereas the demand of rural households is price-inelastic. There are important selection effects, with widowed male household heads being most price-sensitive. Correlating these heterogeneous effects with survey data on informal transfers and health expenditures, our results suggest that informal risk-sharing largely crowds out formal insurance and that a single insurance product may fail to align with poor households' small health budgets. We find no adverse selection into health insurance. |
| Date: | 2018–05–23 |
| URL: | http://d.repec.org/n?u=RePEc:awi:wpaper:0648&r=hea |
| By: | Bénédicte Fonteneau (HIVA, KU Leuven); Sarah Vaes (HIVA, KU Leuven); Jan Van Ongevalle (HIVA, KU Leuven) |
| Abstract: | Social protection has come to feature more and more prominently on international and national development agendas. This quest for social protection in developing countries raises an important question: how can social protection act and be supported as an instrument for redistribution of wealth at the national level? Assessing and enhancing the redistributive potential of social protection mechanisms requires a multidimensional analysis and approach, encompassing political, technical, institutional and financial considerations. This study reports on a two-phased research combining conceptual work (Fonteneau & Van Ongevalle, 2015) with case studies in Senegal and Morocco in order to build and test a theoretical framework that can guide the assessment of the redistributive potential of social protection mechanisms in a developing context. The study offers in-depth insight into two ongoing social protection reforms: the adoption of Law 65.00 in 2002 on Basic Medical Coverage which initiated the introduction of a mandatory health insurance (AMO) for the formal sector and the establishment of a medical assistance scheme for the economically destitute (RAMED) in Morocco; and the ‘Extension of the health coverage through mutual health organisations in the context of decentralisation’ (DECAM) in Senegal. Based on insights from these two case studies, the study calls for development actors to support a maximalist interpretation of redistributive social protection, to make sure their support to social protection reforms is politically-smart, and to promote a more inclusive and meaningful stakeholder participation in policy making processes. The study demonstrates the need for a multidimensional analysis as well as the usefulness of the proposed theoretical framework to guide a comprehensive assessment of the redistributive potential of social protection mechanisms. |
| Keywords: | Social protection, reedistributive social protection, international development, donor funding, financing social protection, political dimensions of social protection |
| JEL: | I I3 |
| Date: | 2017–05 |
| URL: | http://d.repec.org/n?u=RePEc:nam:befdwp:0121&r=hea |