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on Health Economics |
| By: | Razakamanana, Marilys Victoire; Rakotonirainy, Miora; Ramiandrisoa, Tiarinisaina Olivier |
| Abstract: | A health crisis can affect the attitude towards healthcare seeking of the population. During the COVID-19 pandemic, two situations arose: people either sought care out of caution and vigilance, or because of the fear of contracting the virus and the health restrictions, they did not consult the healthcare facilities. This paper aims to analyze the effects of a health crisis such as that of COVID-19 on the use of healthcare in Madagascar. Two diseases, diarrhoea and fever, are considered. Fever is a common symptom of COVID-19, and diarrhoea is one of the causes of morbidity in Madagascar and a less common symptom of the pandemic. Using data from the Multiple Indicator Cluster Survey in 2018 and the Rapid Survey on the Socio-Economic Impact of COVID-19 in Madagascar in 2020 and considering the same individuals surveyed in 2018 and 2020, after verification of the endogeneity, the absence of it was raised. Probit models without instrumental variables are used. During the pandemic, in the case of diarrhoea, faced with the fear of a pandemic, people have sought other alternatives, such as Community Health Workers (CHWs), which is considered less risky than health centres (0.33; p-value=0.05). In the case of fever, people out of caution, prefer to consult health centres rather than self-medicate (-1.86; p-value=0.00). Peoples behaviour differs according to the symptoms of their illness, diarrhoea being less well-known and less frequent as a symptom of Covid-19 than fever. |
| Date: | 2024–08–05 |
| URL: | https://d.repec.org/n?u=RePEc:aer:wpaper:5095dfaa-3047-4a63-a560-71980e36eb23 |
| By: | Adekunle, Wasiu; Oluwaseyi, Vincent |
| Abstract: | The challenge of low health insurance coverage in Nigeria has persisted for decades, hindering access to healthcare, and impacting human capital development negatively. This is despite the diverse types of health insurance schemes co-existing in the country. The current study, therefore, sought to identify the potential factors driving the uptake of health insurance and its types (private and public health insurance) in Nigeria. To achieve the objective, the study assessed cross-sectional data across the 36 States in Nigeria (including the Federal Capital Territory -FCT) obtained from the 2018 Nigeria Demographic and Health Survey (DHS). Accordingly, this study highlighted stylised facts about health insurance and key socio-economic factors, while regression analysis was explored to determine the crucial factors motivating health insurance uptake in Nigeria. The analysis showed that the positive drivers of health insurance uptake (mainly private) include the financial inclusion rate and employment level. The study also observed that due to financial constraints, low-income groups might be less likely to enrol on health insurance than the middle-income and high-income groups. Education is found to have a statistically significant and negative effect on health insurance uptake in the country. On the other hand, health access problems and age of the household head did not have statistically significant effects on health insurance uptake. With the National Health Insurance Authority (NHIA) Act 2021 making health insurance mandatory, it is imperative for the Nigerian government to strengthen the identified positive drivers of health insurance uptake across the country. |
| Date: | 2024–08–05 |
| URL: | https://d.repec.org/n?u=RePEc:aer:wpaper:e7a7a6c3-0e94-4e9d-b805-e1ef1879b8c4 |
| By: | Makate, Marshall; Mahonye, Nyasha |
| Abstract: | Results-based financing (RBF) programme evaluations in sub-Saharan Africa (SSA) have concentrated on quantifying the impact of such programmes on maternal and child health outcomes, worker satisfaction, and quality of care. Very few studies have considered assessing the effectiveness of these programmes from a distributive perspective. This study uses nationally representative data from the Zimbabwe demographic and health survey complemented with geographic location data. As a first step, the empirical approach quantifies wealth-related inequalities in selected maternal and child health outcomes using concentration indices at the district level. A standard difference-in-difference model complemented by kernel-based propensity score matching was used to consistently estimate the impact of the RBF programme on the equality of maternal and child health outcomes across socioeconomic gradients in Zimbabwe by comparing the changes in concentration indices between 2010 and 2015 in ten districts with RBF and thirty districts without the RBF programme for 12 indicators of access to maternal health care and nine indicators of child health outcomes. The results show that the RBF programme was associated with greater and significant improvements in equity related to several outcomes. These outcomes included: prenatal care use (four or more prenatal care visits), family planning, quality of prenatal care (blood pressure checks, iron tablets, and tetanus toxoid vaccinations), child full immunizations, and treatment for fever occurring in the two weeks before the survey. The RBF programme did not appear to ameliorate wealth-related inequality in terms of child low birth weight, neonatal mortality, stunting, diarrhoea prevalence, treatment for diarrhoea, and fever prevalence. A sensitivity check of the estimates indicate that our results are weakly robust to the consideration of absolute measures of inequality (slope index of inequality and the generalized Gini index). From a policy perspective, the results have important implications for public health policies geared towards improving access to maternal and child health care services in developing countries. Our analysis reveals that RBF programmes do not necessarily eliminate wealth-related inequality in maternal and child health outcomes in Zimbabwe but are certainly a useful complement to equity-enhancing policies in the country. |
| Date: | 2024–04–11 |
| URL: | https://d.repec.org/n?u=RePEc:aer:wpaper:46f28e86-bea0-4b4d-85c8-233d87b69140 |
| By: | Gerald J. Pruckner; Thomas Schober |
| Abstract: | Patient selection remains a major challenge in evaluating hospital perfor mance. We exploit the quasi-random assignment of patients to hospitals, based on a rotation schedule between hospitals in the Upper Austrian capital of Linz. In the instrumental variable (IV) framework, we use high-quality administrative data and estimate hospital performance on patient outcomes such as mortality and readmission. We contrast these results with those of traditional risk adjustment models based on patient observables. We find that the assessment of hospital performance is sensitive to the inclusion of patient observables and that increasing the number of socio economic covariates to better control for patient risk profiles does not always help bring risk-adjusted estimates closer to IV estimates. Our results sug gest that common risk adjustment does not adequately control for patient differences between hospitals and that hospital quality indicators based on common administrative data should be interpreted with caution. The trend toward personalized medicine may support the process of collecting more clinical information at the individual level, thus allowing for better quality comparisons between hospitals. |
| Keywords: | Hospital Crowding, Health Care Utilization |
| JEL: | I10 I12 I14 I31 J20 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:jku:econwp:2025-03 |
| By: | Josiane, Saleu Feumeni |
| Abstract: | An equitable healthcare system should be the health policy goal of all countries. The objective of this study is to measure horizontal equity in the use of maternal health services in Cameroon from 2004 to 2018. Specifically, it aims to determine the level of inequity in assistance during delivery and in the intake of tetanus vaccine from 2004 to 2018. It identifies sources of inequity in assistance during delivery and at the intake of tetanus vaccine. To accomplish this, we used the indirect standardization of health care method and the 2004, 2011, and 2018 Demographic and Health Surveys. The results show that there are significant inequities in wealth, education, region of residence, and in access to the nearest health facilities. Furthermore, sociodemographic and economic inequities are associated with health care utilization inequities. A health policy implementation monitoring team is therefore essential if the observed inequities in the use of maternal health services in Cameroon are to be significantly reduced. |
| Date: | 2024–04–11 |
| URL: | https://d.repec.org/n?u=RePEc:aer:wpaper:01303ec7-4f2d-4e57-8f7b-dd45d08ee1a6 |
| By: | Omotayo, Abiodun Olusola; Ogunniyi, Adebayo Isaiah |
| Abstract: | The COVID-19 pandemic resulted in significant income loss for many people, and deepened poverty for individuals and vulnerable populations who were adversely affected through job losses. In South Africa, income loss made it harder to acquire health care and a healthy food, which had a negative impact on health outcomes. This study hypothesized that the COVID-19 shocks disproportionately affects the poor's health, hence the need to know the impact of social protection programmes and interventions through the South Africa Social Security Grant (SASSG). Herewith, we employed the nationally represented, robust and reliable National Income Dynamics Study (NIDS) data set which was conducted in 2017 (pre-COVID-19), with the 1st wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) conducted in 2021 (during COVID-19). The household's per capita total income was used to generate poverty lines, while concentration curves and indices were employed to explain the income-health inequalities. The Difference-in-Difference with fixed effects model was used to estimate the impact of SASSG on the COVID-19 poverty stressors and self-reported health status. Given the significance and magnitude of institutional variables in determining the socioeconomic inequalities in poor health, addressing hunger, income inequality, and unemployment slightly helped to mitigate income-health inequalities during the COVID-19 shocks. We found that the social protection intervention in South Africa (SASSG) cushioned the impact of the COVID-19 pandemic in the context of poverty stressors and self-reported health status. Therefore, we advocate for programmes in South Africa that focus on reducing poverty and health disparities connected to income, as well as more proactive social protection programmes. Key words: COVID-19 shocks; Health capital; Income inequality; Redistribution relationships; Social security grant; South Africa. |
| Date: | 2024–04–10 |
| URL: | https://d.repec.org/n?u=RePEc:aer:wpaper:574d5dfe-1e61-4334-8b9e-bd1ba824d4b5 |
| By: | Marion Leroutier (CREST-ENSAE Paris); Hélène Ollivier (Paris School of Economics, CNRS) |
| Abstract: | This paper shows that even moderate air pollution levels, such as those in Europe, harm the economy by reducing firm performance. Using monthly firm-level data from France, we estimate the causal impact of fine particulate matter (PM2.5) on sales and worker absenteeism. Leveraging exogenous pollution shocks from local wind direction changes, we find that a 10 percent increase in monthly PM2.5 exposure reduces firm sales by 0.4 percent on average over the next two months, with sector-specific variation. Simultaneously, sick leave rises by 1 percent. However, this labor supply reduction explains only a small part of the sales decline. Our evidence suggests that air pollution also reduces worker productivity and dampens local demand. Aligning air quality with WHO guidelines would yield economic benefits on par with the costs of regulation or the health benefits from reduced mortality. |
| Keywords: | Cost of air pollution, Absenteeism, Firm performance |
| JEL: | Q53 I1 J22 |
| Date: | 2025–02–15 |
| URL: | https://d.repec.org/n?u=RePEc:crs:wpaper:2025-05 |
| By: | Haile, Kaleab K. |
| Abstract: | While previous empirical studies extensively examined the determinants of households health insurance (HI) uptake, little has been done to evaluate the accompanying impacts on household welfare and poverty incidence. This study bridges the existing gap in literature by examining the impact of HI on multidimensional household poverty. The data comes from the latest wave of the Ethiopia Socio-economic Survey (ESS) collected in 2018/19. The study uses propensity score matching and inverse probability weighted regression adjustment to even out the distribution of observed characteristics across purchasers and non-purchasers of HI. As these methods could not address simultaneity and self-selection biases, the study uses the endogenous switching analysis, which integrates HI uptake and multidimensional household poverty equations, considering the interdependencies among the equations and their relationships with relevant observed household characteristics. The results reveal that households uptake of HI significantly reduces their probability of being multidimensionally poor. Moreover, the heterogeneous impact assessments of this study show that the desired impact of HI is more pronounced among male-headed households, households with a majority of adult male members, and households in urban areas. This study sheds light on the role of universal health coverage through HI as a policy instrument in the fight against multidimensional deprivations in the context of sub-Saharan Africa. |
| Date: | 2024–04–11 |
| URL: | https://d.repec.org/n?u=RePEc:aer:wpaper:f9ed1181-dada-459d-8dcd-35c38532e99b |
| By: | Gabriella Conti (University College London); Rita Ginja (University of Bergen); Petra Persson; Barton Willage (University of Delaware) |
| Abstract: | The motherhood penalty is well-documented, but what happens at the other end of the reproductive spectrum? Menopause—a transition often marked by debilitating physical and psychological symptoms—also entails substantial costs. Using population-wide Norwegian and Swedish data and quasi-experimental methods, we show that a menopause diagnosis leads to lasting drops in earnings and employment, alongside greater reliance on social transfers. The impact is especially severe for women with lower socioeconomic status. Increasing access to menopause-related health care can help offset these losses. Our findings reveal the hidden economic toll of menopause and the potential gains from better support policies. |
| Keywords: | Norway, Sweden, quasi-experimental variation, social transfers, low socioeconomic status |
| JEL: | H72 I00 I30 J21 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:hka:wpaper:2025-002 |
| By: | Maria Laura Alzua (CEDLAS-IIE-FCE-UNLP & CONICET & PEP); Juan Camilo Cardenas (Universidad de los Andes); Habiba Djebbari (3Aix-Marseille Univ., CNRS, EHESS, Central Marseille, IRD, AMSE, Marseille, France) |
| Abstract: | Experts argue that the adoption of healthy sanitation practices, such as hand washing and latrine use, requires focusing on the entire community rather than individual behaviors. According to this view, one limiting factor in ending open defecation lies in the capacity of the community to collectively act toward this goal. Each member of a community bears the private cost of contributing by washing hands and using latrines, but the benefits through better health outcomes depend on whether other community members also opt out of open defecation. We rely on a community-based intervention carried out in Mali as an illustrative example (Community-Led Total Sanitation or CLTS). Using a series of experiments conducted in 121 villages and designed to measure the willingness of community members to contribute to a local public good, we investigate the process of participation in a collective action problem setting. Our focus is on two types of activities: (1) gathering of community members to encourage public discussion of the collective action problem, and (2) facilitation by a community champion of the adoption of individual actions to attain the socially preferred outcome. In games, communication helps raise public good provision, and both open discussion and facilitated ones have the same impact. When a community member facilitates a discussion after an open discussion session, public good contributions increase, but there are no gains from opening up the discussion after a facilitated session. Community members who choose to contribute in the no-communication treatment are not better facilitators than those who choose not to contribute. |
| JEL: | H41 O12 C93 Q56 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:dls:wpaper:0347 |
| By: | Santiago Burone;; Lukas Leitner; |
| Abstract: | Willingness to pay (WTP) has become an important tool in economic analysis, despite the difficulty to obtain reliable estimates. This paper investigates the occurrence of starting point bias when eliciting WTP for health, a domain where this phenomenon has received limited attention, and illustrates its effect on equivalent consumption, a preference-based well-being measure. In an online experiment, three experimental groups responded to two dichotomous choice questions, with varying initial bids. The treatment groups then provided exact estimates for their WTP in an open-ended question. We find strong evidence for the existence of the bias using both non-parametric and parametric tests, and estimate a sizeable overall effect. Different parametric specifications yield point estimates between 29 and 43 percent for the first bid, whereas the effect of the second bid, which we estimate using an instrumental variable approach, is not statistically different from zero. We propose two ex post approaches to address this effect when using WTP data for interpersonal well-being comparisons. Although the percentage of rankings reversals is relatively small across all feasible comparisons, it becomes notable when examining comparisons for individuals within the same consumption deciles. |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:hdl:wpaper:2501 |
| By: | Ailin He (McGill University); Laetitia Renee (Department of Economics, University of Montreal); Nagham Sayour (Zayed University) |
| Abstract: | We study the impact of affordable after-school care programs on the labor market outcomes of mothers. Specifically, we analyze the effects of a policy implemented in Quebec (Canada) in 1998, which reduced the costs and expanded the availability of after-school care programs for primary school children. To identify the causal effects of the policy, we use tax return data and a triple difference strategy, where we compare mothers of primary school children in Quebec and the rest of Canada, before and after the policy, relative to women with no children. Ten years after the policy implementation, we find an average increase in after-school care use of at least 32 school days. This increase is associated with a significant 11% increase in labor income for mothers with primary school children, mainly driven by an increase at the intensive margin of labor supply. |
| Keywords: | after-school care, maternal income, triple-difference |
| JEL: | J22 J13 J18 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:grc:wpaper:24-04 |
| By: | Giovanis, Eleftherios; Ozdamar, Oznur |
| Abstract: | Governments worldwide have implemented stringent lockdown measures in response to the COVID-19 pandemic outbreak, which has had an adverse impact on employment, affecting people's public life, health, and wellbeing. People have witnessed job losses, cuts in wages, and a decline in their living standards and quality of life. This study aims to estimate the inequalities and wellbeing costs, demonstrating the living standards necessary to make up for people's wage reduction or job losses. In particular, we aim to explore the coping strategies used to enhance their wellbeing compared to those of households without a coping strategy. We use food insecurity as a measure of wellbeing outcomes. The empirical analysis relies on detailed household surveys from the World Bank Microdata Library. We use seven waves of the Panel COVID-19 Rapid Response Phone Survey with Households in 20202022 in Kenya. Also, the results highlight the potential inequalities of the COVID-19 pandemic across gender and types of workers, such as those employed in the informal sector and on temporary contracts. The findings show that specific coping strategies, such as delayed payment obligations, credit purchases, and reduced non-food consumption, are associated with larger inequalities. Regarding the gender of the head of the household, the results suggest that the disparities between female-headed households that had to cope with income and employment loss and female-headed households that did not require to follow any strategy are significantly higher compared to their male counterparts. We derive similar concluding remarks when we consider households with social security coverage and the type of employment contract. Key words: Coping strategies; COVID-19; Food insecurity; Inequalities; Kenya; Panel data; Sub-Saharan region; Risks; World Bank microdata. |
| Date: | 2024–04–10 |
| URL: | https://d.repec.org/n?u=RePEc:aer:wpaper:3daeb29c-3189-48c0-80c4-b5db5e428434 |