nep-hea New Economics Papers
on Health Economics
Issue of 2020‒03‒16
23 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Drinking and Driving By Frank A. Sloan
  2. The Health Toll of Import Competition By Adda, Jérôme; Fawaz, Yarine
  3. Causal mediation analysis with double machine learning By Helmut Farbmacher; Martin Huber; Henrika Langen; Martin Spindler
  4. Anti-Bullying Laws and Suicidal Behaviors among Teenagers By Daniel I. Rees; Joseph J. Sabia; Gokhan Kumpas
  5. Mortality and Healthcare: an Analysis under Epstein-Zin Preferences By Joshua Aurand; Yu-Jui Huang
  6. Are patient-regarding preferences stable? By Wang, Jian; Iversen , Tor; Hennig-Schmidt , Heike; Godager , Geir
  7. Vaccines at Work By Hoffmann, Manuel; Mosquera, Roberto; Chadi, Adrian
  8. State Medicaid Expansion and the Self-Employed By Lee, Jun Yeong; Winters, John V.
  9. Medicaid Physician Fees and Access to Care among Children with Special Health Care Needs By Pinka Chatterji; Sandra Decker; Jason U. Huh
  10. Cigarette Taxes and Teen Marijuana Use By D. Mark Anderson; Kyutaro Matsuzawa; Joseph J. Sabia
  11. Distributional Effects of Tobacco Taxation : A Comparative Analysis By Fuchs,Alan; Gonzalez Icaza,Maria Fernanda; Paz,Daniela Paula
  12. Confirmatory Bias in Health Decisions: Evidence from the MMR-Autism Controversy By Mengcen Qian; Shin-Yi Chou; Ernest K. Lai
  13. Meningococcal Vaccines: An International Comparison of Decision-Making Processes, Frameworks and Methodologies. Are Values Missing? By Hernandez-Villafuerte, K.; Shah, K.; Herdman, M.; Lorgelly, P.
  14. The Three-Gap Model of Health Worker Performance By Ibnat,Fabliha; Leonard,Kenneth L; Bawo,Luke; Mohammed-Roberts,Rianna L.
  15. Sweet child of mine: Parental income, child health and inequality By Nicolas Berman; Lorenzo Rotunno; Roberta Ziparo
  16. Dirty density: air quality and the density of American cities By Carozzi, Felipe; Roth, Sefi
  17. Quantifying the intangible impact of the Olympics using subjective well-being data By Dolan, Paul; Kavetsos, Georgios; Krekel, Christian; Mavridis, Dimitris; Metcalfe, Robert; Senik, Claudia; Szymanski, Stefan; Ziebarth, Nicolas R.
  18. Ethnic Attrition, Assimilation, and the Measured Health Outcomes of Mexican Americans By Antman, Francisca M.; Duncan, Brian; Trejo, Stephen
  19. Out-of-Pocket Expenditures on Health : A Global Stocktake By Wagstaff,Adam; Eozenou,Patrick Hoang-Vu; Smitz,Marc-Francois
  20. Ranking populations in terms of Inequality of health opportunity: A flexible latent type approach By Paolo Brunori; Caterina Francesca Guidi; Alain Trannoy
  21. Food system innovations for healthier diets in low and middle-income countries By de Brauw, Alan; Van den berg, Marrit; Brouwer, Inge D.; Snoek, Harriette; Vignola, Raffaele; Melesse, Mequanint B.; Lochetti, Gaia; Van Wagenberg, Coen; Lundy, Mark; Maître d'Hôtel, Eloide; Ruben, Ruerd
  22. Accounting for Regional Differences in Mother and Child Health : Bangladesh, West Bengal, Bihar, and Jharkhand By Dasgupta,Susmita; Wheeler,David J.
  23. The importance of information on enrollment in a health insurance system: an employee survey in Senegal By Samuel Monteiro

  1. By: Frank A. Sloan
    Abstract: Driving while intoxicated causes many traffic accidents and deaths. Two decisions are closely related, whether to engage in heavy drinking, and to drive, conditional on heavy drinking. This paper reviews the extensive literature on heavy drinking, addiction, and driving after heavy drinking. Relevant public policies involve a combination of deterrence, incapacitation, and treatment. While there is empirical support for the rational addiction model applied to heavy drinking, some attributes of drinker-drivers differ from others (e.g., impulsivity in domains other than alcohol consumption, hyperbolic discounting). Policies most effective in reducing drinking and driving are alcohol excise taxes, minimum drinking age and zero tolerance laws for underage persons, dram shop and social host liability, and criminal sanctions overall. Empirical studies have not determined which specific criminal sanctions are most effective. A major impediment to criminal sanctions as a deterrent is that the probability of being stopped/arrested when driving while intoxicated is extremely low,
    JEL: I12 K14
    Date: 2020–02
  2. By: Adda, Jérôme (Bocconi University); Fawaz, Yarine (CEMFI, Madrid)
    Abstract: This paper assesses the effect of import competition on the labor market and health outcomes of US workers. We first show that import shocks affect employment and income, but only in areas where jobs are more intense in routine tasks. Exploiting over 40 million individual observations on health and mortality, we find that import had a detrimental effect on physical and mental health that is concentrated in those areas and exhibits strong persistence. It decreased health care utilisation and increased hospitalisation for a large set of conditions, more difficult to treat. The mortality hazard of workers in manufacturing increased by up to 6 percent per billion dollar import increase.
    Keywords: import competition, routine tasks, health, health behaviour, hospitalisation, mortality
    JEL: F16 I12 I18
    Date: 2020–01
  3. By: Helmut Farbmacher; Martin Huber; Henrika Langen; Martin Spindler
    Abstract: This paper combines causal mediation analysis with double machine learning to control for observed confounders in a data-driven way under a selection-on-observables assumption in a high-dimensional setting. We consider the average indirect effect of a binary treatment operating through an intermediate variable (or mediator) on the causal path between the treatment and the outcome, as well as the unmediated direct effect. Estimation is based on efficient score functions, which possess a multiple robustness property w.r.t. misspecifications of the outcome, mediator, and treatment models. This property is key for selecting these models by double machine learning, which is combined with data splitting to prevent overfitting in the estimation of the effects of interest. We demonstrate that the direct and indirect effect estimators are asymptotically normal and root-n consistent under specific regularity conditions and investigate the finite sample properties of the suggested methods in a simulation study when considering lasso as machine learner. We also provide an empirical application to the U.S. National Longitudinal Survey of Youth, assessing the indirect effect of health insurance coverage on general health operating via routine checkups as mediator, as well as the direct effect. We find a moderate short term effect of health insurance coverage on general health which is, however, not mediated by routine checkups.
    Date: 2020–02
  4. By: Daniel I. Rees; Joseph J. Sabia; Gokhan Kumpas
    Abstract: The CDC reports that the association between bullying and suicides among teenagers has generated “concern, even panic,” but polices aimed at combatting bullying have received little attention from researchers. Using a difference-in-differences estimation strategy, we find that state-level anti-bullying laws (ABLs) reduce bullying victimization, depression and suicidal ideation, with the largest estimated effects for female teenagers and teenagers who identify as lesbian, gay, bisexual, or questioning. In addition, ABLs are associated with a 13-16 percent reduction in the suicide rate of female 14- through 18-year-olds. Event-study analyses and falsification tests provide evidence that these estimates can be interpreted causally.
    JEL: I12 I18
    Date: 2020–02
  5. By: Joshua Aurand; Yu-Jui Huang
    Abstract: This paper investigates optimal consumption, investment, and healthcare spending under Epstein-Zin preferences. Given consumption and healthcare spending plans, Epstein-Zin utilities are defined over an agent's random lifetime, partially controllable by the agent as healthcare reduces Gompertz' natural growth rate of mortality. In a Black-Scholes market, the stochastic optimization problem is solved through the associated Hamilton-Jacobi-Bellman (HJB) equation. Compared with classical Epstein-Zin utility maximization, the additional controlled mortality process complicates the uniqueness of Epstein-Zin utilities and verification arguments. A combination of probabilistic arguments and analysis of the HJB equation are required to resolve the challenges. In contrast to prior work under time-separable utilities, Epstein-Zin preferences largely facilitate calibration. In five different countries we examined, the model-generated mortality closely approximates actual mortality data; moreover, the calibrated efficacy of healthcare is in close agreement with empirical studies on healthcare across countries.
    Date: 2020–03
  6. By: Wang, Jian (Department of Health Management and Health Economics); Iversen , Tor (Department of Health Management and Health Economics); Hennig-Schmidt , Heike (Department of Economics, University of Bonn); Godager , Geir (Department of Health Management and Health Economics)
    Abstract: We quantify patient-regarding preferences by fitting a bounded rationality model to data from an incentivized laboratory experiment, where Chinese medical doctors, German medical students and Chinese medical students decide under different payment schemes. We find a remarkable stability in patient-regarding preferences when comparing subject pools and we cannot reject the hypothesis of equal patient-regarding preferences in the three groups. The results suggest that a health economic experiment can provide knowledge that reach beyond the student subject pool, and that the preferences of decision-makers in one cultural context can be of relevance in a very different cultural context.
    Keywords: Laboratory experiment; Bounded rationality; Payment mechanism; Physician behavio
    JEL: C92 D82 H40 I11 J33
    Date: 2019–04–17
  7. By: Hoffmann, Manuel (Texas A&M University); Mosquera, Roberto (Universidad de las Américas); Chadi, Adrian (University of Konstanz)
    Abstract: Influenza vaccination could be a cost-effective way to reduce costs in terms of human lives and productivity losses, but low take-up rates and vaccination unintentionally causing moral hazard may decrease its benefits. We ran a natural field experiment in cooperation with a bank in Ecuador, where we modified its vaccination campaign. Experimentally manipulating incentives to participate in this health intervention allows us to study peer effects with organizational data and to determine the personal consequences of being randomly encouraged to get vaccinated. We find that assigning employees to get vaccinated during the workweek roughly doubled take-up compared to employees assigned to the weekend, which indicates that reducing opportunity costs plays an important role in increasing vaccination rates. Coworker take-up also increased individual take-up significantly and is driven by social norms. Contrary to the company's expectation, vaccination did not reduce sickness absence during the flu season. Getting vaccinated was ineffective with no measurable health externalities from coworker vaccination. We rule out meaningful individual health effects when considering several thresholds of expected vaccine effectiveness. Using a dataset of administrative records on medical diagnoses and employee surveys, we find evidence consistent with vaccination causing moral hazard, which could decrease the effectiveness of vaccination.
    Keywords: health intervention, flu vaccination, sickness-related absence, field experiment, random encouragement design, moral hazard, technology adoption
    JEL: D90 I12 J01 N36
    Date: 2020–01
  8. By: Lee, Jun Yeong (Iowa State University); Winters, John V. (Iowa State University)
    Abstract: This paper examines effects of state Medicaid Expansion via the Affordable Care Act on the self-employed. We first examine impacts on the probability of self-employment and find no significant effect. We then examine the probability of having health insurance and the type of coverage for self-employed persons. Medicaid expansion increased overall health insurance coverage rates, with especially large impacts for the unincorporated self-employed. Medicaid expansion also increased the probability of Medicaid coverage as expected, but there is evidence of crowd out of other types of coverage. Impacts on health insurance rates of the self-employed also strengthened over time.
    Keywords: health insurance, self-employed, Affordable Care Act, state Medicaid expansion
    JEL: H51 I13 L26
    Date: 2020–02
  9. By: Pinka Chatterji; Sandra Decker; Jason U. Huh
    Abstract: The objective of this study is to use data from the National Survey of Children with Special Health Care Needs (NS-CSHCN) to test whether Medicaid physician fees are correlated with access to health services and adequacy of insurance coverage among CSHCN. We use a difference-in-differences method, comparing the effects of Medicaid physician fees on outcomes of publicly-insured children in states that raised fees vs. in states that did not. We also consider a triple difference specification using privately-insured children as the comparison group. Our findings indicate that raising the Medicaid primary care fee level close to at least 90 percent of the Medicare level reduces the likelihood that publicly-insured CSHCN lack a usual source of care in a doctor’s office by about 15 percent. Fee increases are also associated with improved access to specialty doctor care, and large improvements in caregivers’ satisfaction with the adequacy of health insurance coverage, among publicly-insured CSHCN. Results for some other access measures, such as global measures of having difficulties and delays accessing services, were mixed.
    JEL: I1 I13
    Date: 2020–02
  10. By: D. Mark Anderson; Kyutaro Matsuzawa; Joseph J. Sabia
    Abstract: The spillover effect of cigarette taxes on youth marijuana use has been the subject of intense public debate. Opponents of cigarette taxes warn that tax hikes will cause youths to substitute toward marijuana. On the other hand, public health experts often claim that because tobacco is a “gateway” drug, higher cigarette taxes will deter youth marijuana use. Using data from the National and State Youth Risk Behavior Surveys (YRBS) for the period 1991-2017, we explore the relationship between state excise taxes on cigarettes and teen marijuana use. In general, our results fail to support either of the above hypotheses. Rather, we find little evidence to suggest that teen marijuana use is sensitive to changes in the state cigarette tax. This null result holds for the sample period where cigarette taxes are observed to have the largest effect on teen cigarette use and across a number of demographic groups in the data. Finally, we find preliminary evidence that the recent adoption of state e-cigarette taxes is associated with a reduction in youth marijuana use.
    JEL: I12 I18 K42
    Date: 2020–02
  11. By: Fuchs,Alan; Gonzalez Icaza,Maria Fernanda; Paz,Daniela Paula
    Abstract: Tobacco taxes have positive impacts on health outcomes. However, policy makers often hesitate to use them because of the perception that poorer households are affected disproportionally more than richer households. This study compares the simulated distributional effects of tobacco tax increases in eight low- and middle-income countries. It applies a standardized extended cost-benefit analysis methodology and relies on comparable data sources across countries. The net effect of raising taxes on cigarettes encompasses the direct negative price shock to household budgets and the long-term benefits of improved health outcomes. The distributional incidence is assessed by estimating decile-specific behavioral responses and relative income gains. The comparative results do not support the claim that tobacco taxes are necessarily regressive. Although welfare losses from the first-order price shock disproportionally affect the poor, these negative shocks are attenuated by greater price-responsiveness among lower-income groups and further offset by higher long-term relative gains through reduced medical expenditures and additional years of productive life as taxes dissuade smoking. In several countries, increasing the price of cigarettes is pro-poor and welfare improving for a large share of the population. Along with raising taxes, policy should aim at encouraging responsiveness to price changes and target tobacco-related medical expenses that disproportionally burden the poor.
    Date: 2019–04–08
  12. By: Mengcen Qian; Shin-Yi Chou; Ernest K. Lai
    Abstract: Since Wakefield et al. (1998), the public was exposed to mixed information surrounding the claim that measles-mumps-rubella vaccine causes autism. A persistent trend to delay the vaccination during 1998–2011 in the US was driven by children of college-educated mothers, suggesting that these mothers held biases against the vaccine influenced by the early unfounded claim. Consistent with confirmatory bias, exposures to negative information about the vaccine strengthened their biases more than exposures to positive information attenuated them. Positive online information, however, had strong impacts on vaccination decisions, suggesting that online dissemination of vaccine-safety information may help tackle the sticky misinformation.
    JEL: I12 I18 I26
    Date: 2020–02
  13. By: Hernandez-Villafuerte, K.; Shah, K.; Herdman, M.; Lorgelly, P.
    Abstract: Meningococcal disease is a life-threatening infection and can result in severe sequelae. Recent scientific and technical advances have led to the discovery and implementation of novel meningococcal vaccines which have resulted in a substantial reduction in the burden of disease worldwide, representing a major public health achievement (Crum-Cianflone and Sullivan, 2016).
    Keywords: Judging value for money and improving decision making; Measuring and valuing outcomes
    JEL: I1
    Date: 2020–03–01
  14. By: Ibnat,Fabliha; Leonard,Kenneth L; Bawo,Luke; Mohammed-Roberts,Rianna L.
    Abstract: The Three-Gap Model examines the determinants of low-quality health care by examining the patterns and determinants of three gaps. Using four measures of performance -- target performance, actual performance, capacity to perform, and knowledge to perform -- this paper defines three gaps for each health worker: the gap between target performance and what they have the knowledge to do (the know gap), the gap between their knowledge and their capacity to perform (the know-can gap), and the gap between their capacity and what they actually do (the can-do gap). The paper demonstrates how the patterns of these gaps across health workers in a sample can be used to diagnose failures in the system as well as evaluate the outcomes of policy experiments. Using data on pediatric care from hospitals in Liberia, the paper illustrates how the model can be used to investigate the potential for improvements in the quality of care from several possible policy interventions. The analysis of the relationships between these gaps across health workers in a health system help to paint a better picture of the determinants of performance and can assist policy makers in choosing relevant policies to improve health worker performance.
    Keywords: Health Care Services Industry,Health Service Management and Delivery,Pharmaceuticals Industry,Pharmaceuticals&Pharmacoeconomics
    Date: 2019–03–14
  15. By: Nicolas Berman (Aix-Marseille Univ, CNRS, EHESS, Ecole Centrale, AMSE, Marseille, France.); Lorenzo Rotunno (Aix-Marseille Univ, CNRS, EHESS, Ecole Centrale, AMSE, Marseille, France.); Roberta Ziparo (Aix-Marseille Univ, CNRS, EHESS, Ecole Centrale, AMSE, Marseille, France.)
    Abstract: How to allocate limited resources among children is a crucial household decision, especially in developing countries where it might have strong implications for children and family survival. We study how variations in parental income in the early life of their children affect subsequent child health and parental investments across siblings, using micro data from multiple waves of the Demographic and Health Survey (DHS) spanning 54 developing countries. Variations in the world prices of locally produced crops are used as measures of local income. We find that children born in periods of higher income durably enjoy better health and receive better human capital (health and education) investments than their siblings. Children whose older siblings were born during favourable income periods receive less investment and exhibit worse health in absolute terms. We interpret these within-household reallocations in light of economic and evolutionary theories that highlight the importance of efficiency considerations in competitive environments. Finally, we study the implications of these for aggregate child health inequality, which is found to be higher in regions exposed to more volatile crop prices.
    Keywords: health, income, parental investments, intra-household allocations
    JEL: O12 I14 I15 D13 J13
    Date: 2020–03
  16. By: Carozzi, Felipe; Roth, Sefi
    Abstract: We study whether urban density affects the exposure of city dwellers to ambient air pollution using satellite-derived measures of air quality for the contiguous United States. For identification, we rely on an instrumental variable strategy, which induces exogenous variation in density without affecting pollution directly. For this purpose, we use three variables measuring geological characteristics as instruments for density: earthquake risks, soil drainage capacity and the presence of aquifers. We find a positive and statistically significant pollution-density elasticity of 0.13. We also assess the health implications of our findings and find that doubling density in an average city increases annual mortality costs by as much as $630 per capita. Our results suggest that, despite the common claim that denser cities tend to be more environmentally friendly, air pollution exposure is higher in denser cities. This in turn highlights the possible trade-off between reducing global greenhouse gas emissions and preserving environmental quality within cities.
    Keywords: air pollution; urban congestion; density; health
    JEL: Q53 R11 I10
    Date: 2019
  17. By: Dolan, Paul; Kavetsos, Georgios; Krekel, Christian; Mavridis, Dimitris; Metcalfe, Robert; Senik, Claudia; Szymanski, Stefan; Ziebarth, Nicolas R.
    Abstract: Hosting the Olympic Games costs billions of taxpayer dollars. Following a quasi-experimental setting, this paper assesses the intangible impact of the London 2012 Olympics, using a novel panel of 26,000 residents in London, Paris, and Berlin during the summers of 2011, 2012, and 2013. We show that hosting the Olympics increases subjective well-being of the host city's residents during the event, particularly around the times of the opening and closing ceremonies. However, we do not find much evidence for legacy effects. Estimating residents' implicit willingness-to-pay for the event, we do not find that it was worth it for London alone, but a modest well-being impact on the rest of the country would make hosting worth the costs.
    Keywords: Subjective well-being; Life satisfaction; Happiness; Intangible effects; Olympic Games; Sport events; Quasi-natural experiment
    JEL: I30 I31 I38 L83
    Date: 2019–08
  18. By: Antman, Francisca M. (University of Colorado, Boulder); Duncan, Brian (University of Colorado Denver); Trejo, Stephen (University of Texas at Austin)
    Abstract: The literature on immigrant assimilation and intergenerational progress has sometimes reached surprising conclusions, such as the puzzle of immigrant advantage which finds that Hispanic immigrants sometimes have better health than U.S.-born Hispanics. While numerous studies have attempted to explain these patterns, almost all studies rely on subjective measures of ethnic self-identification to identify immigrants' descendants. This can lead to bias due to "ethnic attrition," which occurs whenever a U.S.-born descendant of a Hispanic immigrant fails to self-identify as Hispanic. In this paper, we exploit information on parents' and grandparents' place of birth to show that Mexican ethnic attrition, operating through intermarriage, is sizable and selective on health, making subsequent generations of Mexican immigrants appear less healthy than they actually are. Consequently, conventional estimates of health disparities between Mexican Americans and non-Hispanic whites as well as those between Mexican Americans and recent Mexican immigrants have been significantly overstated.
    Keywords: assimilation, immigrant health advantage, ethnic attrition
    JEL: J15 J12 I14
    Date: 2020–01
  19. By: Wagstaff,Adam; Eozenou,Patrick Hoang-Vu; Smitz,Marc-Francois
    Abstract: This paper provides an overview of research on out-of-pocket health expenditures, reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of gross domestic product spent on health. The two measures of dispersion or risk -- the coefficient of variation and Q90/Q50 -- are only weakly correlated across countries and not explained by the macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of"catastrophic"expenditures. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.
    Keywords: Health Care Services Industry,Inequality,Health Economics&Finance,Labor&Employment Law
    Date: 2019–04–08
  20. By: Paolo Brunori (University of Florence); Caterina Francesca Guidi (European University Institute); Alain Trannoy (Aix-Marseille University)
    Abstract: We offer a flexible latent type approach to rank populations according to unequal health opportunities. Building upon the latent-class method proposed by Li Donni et al. (2015), our contribution is to let the number of types vary to obtain an opportunity-inequality curve for a population that gives how the between-type inequality varies with the number of types. A population A is said to have less inequality of opportunity than population B if its curve is statistically below that of population B. This version of the latent class approach allows for a robust ranking of 31 European countries regarding inequality of opportunity in health.
    Keywords: nequality of opportunity, health inequality, latent class, opportunity-inequality curve, self-assessed health.
    JEL: I14 D63
    Date: 2020–01
  21. By: de Brauw, Alan; Van den berg, Marrit; Brouwer, Inge D.; Snoek, Harriette; Vignola, Raffaele; Melesse, Mequanint B.; Lochetti, Gaia; Van Wagenberg, Coen; Lundy, Mark; Maître d'Hôtel, Eloide; Ruben, Ruerd
    Abstract: Malnutrition in all its forms is a major challenge everywhere in the world, and particularly in low and middle income countries. To reduce malnutrition, innovations in food systems are needed to both provide sufficient options for consumers to obtain diets with adequate nutritional value, and to help consumers make conscious and unconscious choices to choose healthier diets. A potential solution to this challenge is food systems innovations designed to lead to healthier diets. In this paper, we lay out a multidisciplinary framework for both identifying and analyzing innovations in food systems that can lead to improvements in the choices available to consumers and their diets from a health perspective. The framework identifies entry points for the design of potential food systems innovations, highlighting potential synergies, feedback, and tradeoffs within the food system. The paper concludes by providing examples of potential innovations and describes future research that can be developed to support the role of food systems in providing healthier diets.
    Keywords: food systems, innovations, food fortification, taxes, subsidies, regulations, food supply chain, healthier diets, research framework, public food acquisition programs, information campaigns,
    Date: 2019
  22. By: Dasgupta,Susmita; Wheeler,David J.
    Abstract: Using recent Demographic Health Survey data for Bangladesh and the neighboring Indian states of Bihar, Jharkhand, and West Bengal, this paper reexamines the determinants of child wasting and maternal anemia. The findings bear out the importance of commonly cited factors, such as mother?s education and age, household wealth, and child birth order. However, the findings also highlight significant and large regional differences between Indian states and Bangladeshi provinces. For example, the results for Jharkhand state in India and Barisal province in Bangladesh indicate that controlling for those commonly cited determinants, the poorest, least-educated mothers and their children in Barisal have better health outcomes than the wealthiest, best-educated counterparts in Jharkhand. Mapping analysis of the spatial variations in child wasting and maternal anemia shows clear patterns of clustering over large areas that frequently overlap state/province and national boundaries. Possible sources of these striking differences include spatially differentiated prices and availability of critical nutrients; dietary preferences related to religion and ethnicity; nutrition education; and administration of public health and nutrition policy.
    Keywords: Educational Sciences,Health Care Services Industry,Nutrition,Reproductive Health,Early Child and Children's Health
    Date: 2019–03–28
  23. By: Samuel Monteiro (I&P - Investisseurs et Partenaires)
    Abstract: Using a unique database of 204 employees in Senegal, this paper seeks to understand the determinants leading to the choice to enroll (or not) in a health insurance plan. To answer this question, we created three surveys to test certain preferences (time preference and risk aversion) and the role of information. In this paper, we show that Senegalese employees have a very strong preference for the present and a low aversion to loss, which could cause them to not take out insurance. We find that access to information on health insurance plays an essential role in the willingness to enroll. While 12% of employees who received no information about health insurance said they would not want to be insured if they could choose, this proportion dropped to 2% among employees who received positive information about health insurance. These results are econometrically confirmed when controlling for other factors such as gender, age and education. These results show the importance of information on people's perception of health insurance. It is therefore essential to communicate on the functioning of health insurance and the benefits of being covered in order to strengthen adherence to a health insurance system.
    Keywords: Health insurance,Risk aversion,Time preferences,Information,Africa
    Date: 2019–12–30

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