nep-ias New Economics Papers
on Insurance Economics
Issue of 2020‒08‒31
twenty-six papers chosen by
Soumitra K. Mallick
Indian Institute of Social Welfare and Business Management

  1. Do Older Workers Without Benefits Find Health and Retirement Coverage? By Matthew S. Rutledge
  2. Mortality Effects and Choice Across Private Health Insurance Plans By Jason Abaluck; Mauricio M. Caceres Bravo; Peter Hull; Amanda Starc
  3. Employment Effects of Unemployment Insurance Generosity During the Pandemic By Scott, Dana; Finamor, Lucas
  4. Benchmarked Risk Minimizing Hedging Strategies for Life Insurance Policies By Jin Sun; Eckhard Platen
  5. Australia; Financial Sector Assessment Program-Technical Note-Insurance Sector: Regulation and Supervision By International Monetary Fund
  6. Information Asymmetry and Insurance in Africa By Simplice A. Asongu; Nicholas M. Odhiambo
  7. A Natural Disasters Index By Thilini V. Mahanama; Abootaleb Shirvani
  8. Unemployment Insurance during a Pandemic By Jun Nie; Zoe Xie
  10. Once covered, forever covered: The actuarial challenges of the Belgian private health insurance system By Hanbali, Hamza; Claassens, Hubert; Denuit, Michel; Dhaene, Jan; Trufin, Julien
  11. Home and Motor insurance joined at a household level using multivariate credibility By Pechon, Florian; Denuit, Michel; Trufin, Julien
  12. Who Goes on Disability when Times are Tough? The Role of Work Norms among Immigrants By Furtado, Delia; Papps, Kerry L.; Theodoropoulos, Nikolaos
  13. Integrated Appeal and Grievance Processes for Integrated D-SNPs with “Exclusively Aligned Enrollment†By Ryan Stringer; Alena Tourtellotte
  14. Size-biased transform and conditional mean risk sharing, with application to P2P insurance and tontines By Denuit, Michel
  15. Provider Engagement Toolkit By Nazihah Siddiqui; Sonya Streeter; Ethan Jacobs; Rumin Sarwar
  16. Contagion without deposit insurance: The South African small bank crisis of 2002/3 By Roy Havemann
  17. Obamacare and a Fix for the IRS Iteration By Samuel J. Ferguson
  18. How Do DI Benefits for Uncovered Public Workers Compare to SSDI? By Anek Belbase; Laura D. Quinby
  19. Health-policyholder clustering using health consumption By Romain Gauchon; Stéphane Loisel; Jean-Louis Rullière
  20. Stochastic Modelling of the COVID-19 Epidemic By Eckhard Platen
  21. Pricing foreseeable and unforeseeable risks in insurance portfolios By Weihong Ni; Corina Constantinescu; Alfredo Eg\'idio dos Reis; V\'eronique Maume-Deschamps
  22. Montenegro; Technical Assistance Report-Financial Soundness Indicators Mission (November 29 - December 5, 2017) By International Monetary Fund
  23. Introduction to Heterogeneity Series III: Credit Market Outcomes By Rajashri Chakrabarti
  24. It Takes Two to Tango : Income and Payroll Taxes in Progressive Tax Systems By Victor Amoureux; Elvire Guillaud; Michaël Zemmour
  25. Comprehensive Primary Care Plus (CPC+) Model: Findings at a Glance Evaluation of Second Year (2018) By Deborah Peikes; Grace Anglin; Janice Genevro; et al.
  26. Soins prénatals et accouchement assisté en Guinée By Mamadou Saliou Balde; Balde Saliou

  1. By: Matthew S. Rutledge
    Abstract: Since World War II, many workers have come to count on their jobs to provide health insurance and retirement plans. Indeed, the presence of these benefits is often seen as a marker of Òtraditional employmentÓ or, simply, a Ògood job.Ó When workers miss out on these benefits through their employer, to what extent do they find alternative sources? This brief, based on a recent study, explores how older workers in Ònontraditional jobsÓ that lack such benefits can gain health insurance and retirement coverage outside the employment relationship. On the health side, workers have several options, including a spouseÕs employer, an individual insurance policy, and public programs such as Medicaid. On the retirement side, workersÕ main options are to save through an individual retirement account (IRA) or rely on a spouse with a 401(k) to save more to compensate. The discussion proceeds as follows. The first section describes the measure of nontraditional work and the characteristics of older workers with these jobs. The second section identifies the possible sources of health insurance for the workers in nontraditional jobs, noting an uptick in non-employer alternatives after the introduction of the Affordable Care Act (ACA). The third section looks at retirement saving options for the workers in nontraditional jobs, assessing the potential of IRAs and spousal 401(k)s. The final section concludes that, on the health side, most older workers in nontraditional jobs are able to find coverage, often through their spouseÕs employer or, increasingly, Medicaid, but about one-third remain uninsured. On the retirement side, older workers with nontraditional jobs largely end up with no viable savings option.
    Date: 2020–07
  2. By: Jason Abaluck; Mauricio M. Caceres Bravo; Peter Hull; Amanda Starc
    Abstract: Competition in health insurance markets may fail to improve health outcomes if consumers are not willing to pay for high quality plans. We document large differences in the mortality rates of Medicare Advantage (MA) plans within local markets. We then show that when high (low) mortality plans exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower (higher) mortality. We develop a framework that uses this variation to estimate the relationship between observed mortality rates and causal mortality effects; we find a tight link. We then extend the framework to study other predictors of mortality effects and estimate consumer willingness to pay. Higher spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Moving beneficiaries out of the bottom 5% of plans could save tens of thousands of elderly lives each year.
    JEL: C26 I11 J14
    Date: 2020–07
  3. By: Scott, Dana; Finamor, Lucas
    Abstract: In response to the Covid-19 pandemic, the United States enacted the CARES Act, which expanded unemployment insurance (UI) benefits by providing a $600 weekly payment in addition to state unemployment benefits. We test whether changes in UI benefit generosity are associated with decreased employment, both at the onset of the benefits expansion and as businesses began to reopen. We use data from Homebase, a private firm that provides scheduling and time clock software to small businesses, which allows us to exploit high-frequency observations to understand how firms and workers respond to policy changes in real time. While our results show that relative declines in employment and hours occurred in mid-March, we find that the workers with higher post-CARES replacement rates did not experience larger declines in employment or hours of work when the benefits expansion went into effect. They have also returned to their previous jobs over time at similar rates as others.
    Keywords: Unemployment Insurance, Employment, COVID-19, CARES Act
    JEL: J64 J68
    Date: 2020–08–12
  4. By: Jin Sun; Eckhard Platen (Finance Discipline Group, UTS Business School, University of Technology Sydney)
    Abstract: Traditional life insurance policies offer no equity investment opportunities for the premium paid, and suffer from low returns over the long insurance terms. Modern equity-linked insurance policies offer equity investment opportunities exposed to equity market risk. To combine the low-risk of traditional policies with the high returns offered by equity-linked policies, we consider insurance policies under the benchmark approach (BA), where the policyholders’ funds are invested in the growth-optimal portfolio and the locally risk-free savings account. Under the BA, life insurance policies can be delivered at their minimal costs, lower than the classical actuarial theory predicts. Due to unhedgeable mortality risk, life insurance policies cannot be fully hedged. In this case benchmarked risk-minimization can be applied to obtain hedging strategies with minimally fluctuating profit and loss processes, where the fluctuations can further be reduced through diversification.
    Keywords: benchmark approach; benchmarked risk minimization; life insurance; mortality model
    JEL: G13 G22
    Date: 2019–03–01
  5. By: International Monetary Fund
    Abstract: This technical note provides an update on the Australian insurance sector and an analysis of certain key aspects of the regulatory and supervisory regime. The note analyzes the practice in relation to selected Insurance Core Principles (ICPs) in the context of a wider discussion of key issues in regulation and supervision. Despite the negative impact of the low interest rate environment, the life insurance industry retains sufficient loss absorption capacity. The Australian Prudential Regulation Authority (APRA) has undertaken a comprehensive reform of prudential regulation while improving the consistency of the framework between life and general insurers. This focused review confirms that prudential regulation and supervision by APRA is reasonably conservative. The risk-based capital framework is reasonably conservative, which facilitates supervisory risk assessments. APRA has high technical capacity to conduct effective supervision. While there are some gaps in the regulatory regime, APRA seeks to address these through its supervisory process. The report recommends that APRA should expand and deepen its scrutiny of group activities, especially those entailing risky investments and material intragroup transactions.
    Keywords: Economic growth;Financial crises;Consumer credit;Health insurance;Financial regulation and supervision;life insurer,APRA,ASIC,insurer,policyholder
    Date: 2019–02–21
  6. By: Simplice A. Asongu (Yaounde, Cameroon); Nicholas M. Odhiambo (Pretoria, South Africa)
    Abstract: In this study, we assess the relevance of decreasing information asymmetry on life and non-life insurance consumption, by using data from 48 African countries during the period 2004-2014. Reduced information asymmetry is proxied by information sharing offices, namely: public credit registries and private credit bureaus. The empirical evidence is based on the Generalised Method of Moments. The findings show that information sharing offices increase insurance consumption with a comparatively higher magnitude in life insurance penetration, relative to non-life insurance penetration. Practical and theoretical implications are discussed.
    Keywords: Insurance; Information Asymmetry
    JEL: I30 G20 G22 O16 O55
    Date: 2020–01
  7. By: Thilini V. Mahanama; Abootaleb Shirvani
    Abstract: Natural disasters, such as tornadoes, floods, and wildfire pose risks to life and property, requiring the intervention of insurance corporations. One of the most visible consequences of changing climate is an increase in the intensity and frequency of extreme weather events. The relative strengths of these disasters are far beyond the habitual seasonal maxima, often resulting in subsequent increases in property losses. Thus, insurance policies should be modified to endure increasingly volatile catastrophic weather events. We propose a Natural Disasters Index (NDI) for the property losses caused by natural disasters in the United States based on the "Storm Data" published by the National Oceanic and Atmospheric Administration. The proposed NDI is an attempt to construct a financial instrument for hedging the intrinsic risk. The NDI is intended to forecast the degree of future risk that could forewarn the insurers and corporations allowing them to transfer insurance risk to capital market investors. This index could also be modified to other regions and countries.
    Date: 2020–08
  8. By: Jun Nie; Zoe Xie
    Abstract: The CARES Act implemented in response to the COVID-19 crisis dramatically increased the generosity of unemployment insurance (UI) benefits, triggering concerns about substantial effects on unemployment. This paper combines a labor market search-matching model with the SIR-type infection dynamics to study the effects of the CARES Act UI on both unemployment and infection. More generous UI policies create work disincentives and lead to higher unemployment but also reduce infection and save lives. Economic shutdown policies further amplify these effects of UI policies. Quantitatively, the CARES UI policies raise unemployment by an average of 3.7 percentage points over April to December 2020, but also reduce cumulative death by 4.7 percent. Eligibility expansion and the extra $600 increase in benefit level account for over 90 percent of the total effects, while the 13-week benefit duration extension plays a much smaller role. Overall, UI policies improve the welfare of workers and reduce the welfare of non-workers, both young and old.
    Keywords: COVID-19; Unemployment insurance; CARES Act; Search and matching models
    JEL: E24 J64 J65
    Date: 2020–08–06
  9. By: George Pasmangiu (Bucharest University of Economic Studies)
    Abstract: Often it is implied that financial stability is synonymous with macroeconomic stability, but the two concepts do not reflect the same context. A composite Financial Stability Index (FSI) should accurately represent the components of a financial market. In Romania, the money market along with the capital market, the insurance market, and the private pensions market form the entirety of the financial market. A macroeconomic stability index should represent the overall situation of all economic markets within a country. The main purpose of this paper is to design a better, more suitable aggregate index that best describes the notion of financial stability. The composite Financial Stability Index signals through its components, the general financial conditions of a nation?s economy. This paper explores the constituent economic variables for Romania that would lead to the completion of an improved aggregate index and the evolution of said index. Romania entered the last decade in the middle of a financial crisis that delayed its economic development and the accession to the euro area. To determine the trend of the financial market in Romania during the last decade, a VAR model and Principal Component Analysis (PCA) are used to conduct an econometric analysis for the 2010-2019 period. The results of this study demonstrate that, even though the Romanian financial market was weakened from the beginning of the analyzed period, it gradually managed to reach financial stability in the more recent years, although residual instability still remains a possibility in the near future. The modeled econometric data was collected from various international and national databases, such as Thomson Reuters Eikon platform, The National Bank of Romania (NBR) database, and The Financial Supervisory Authority (ASF) reports.
    Keywords: capital market, financial market, financial stability index, money market, VAR model
    JEL: C32 C38 E44
  10. By: Hanbali, Hamza; Claassens, Hubert; Denuit, Michel; Dhaene, Jan; Trufin, Julien
    Date: 2019–01–01
  11. By: Pechon, Florian; Denuit, Michel; Trufin, Julien
    Date: 2019–01–01
  12. By: Furtado, Delia; Papps, Kerry L.; Theodoropoulos, Nikolaos
    Abstract: We examine how work norms affect Social Security Disability Insurance (SSDI) take-up rates in response to worsening economic conditions. By focusing on immigrants in the US, we can consider the influence of work norms in a person’s home country, which we argue are exogenous to labor market prospects in the US. We find that the probability of receiving SSDI is more sensitive to economic downturns among immigrants from countries where people place less importance on work. We also provide evidence that this result is not driven by differential sensitivities to the business cycle or differences in SSDI eligibility.
    Keywords: Disability Insurance,Immigrants,Social Norms,Unemployment Rates
    JEL: H55 J61 I18 J15
    Date: 2020
  13. By: Ryan Stringer; Alena Tourtellotte
    Abstract: Individuals dually eligible for Medicare and Medicaid must navigate separate, and in some cases conflicting, appeal and grievance processes within Medicare and Medicaid.
    Keywords: appeal, grievance, D-SNP
  14. By: Denuit, Michel
    Date: 2019–01–01
  15. By: Nazihah Siddiqui; Sonya Streeter; Ethan Jacobs; Rumin Sarwar
    Abstract: This provider engagement toolkit describes a variety of strategies used by ACOs to engage health care providers in the ACO and in quality improvement activities.
    Keywords: Provider Engagement Toolkit, Medicare accountable care organizations, Learning systems for accountable care organizations, LSACO, Medicare ACO
  16. By: Roy Havemann
    Abstract: Following the failure of Saambou bank in February 2002, another seven South African banks failed within a month, including the ï¬ fth-largest, and a further ï¬ ve within a year. In total, twenty-two small and mid-sized banks deregistered over two years: half the total number of banks, and nearly 10 per cent of the deposit base. South Africa is one of the few jurisdictions that does not have a explicit deposit insurance scheme. While such a scheme may have prevented the ï¬ rst failure, I show that it would not have prevented contagion. The banks that failed were all well capitalised and solvent, but had relatively high levels of short-term funding from non-bank ï¬ nancial institutions. They would not have qualiï¬ ed for a retail deposit insurance scheme, and would still have experienced a run of non-bank funding. This highlights that deposit insurance is best seen as a tool that should be used for its stated purposes (protecting vulnerable depositors), and not as a general ï¬ nancial stability tool that can prevent contagion. Indeed, if agents expect that the authorities will use deposit insurance to ‘bail-out’ a bank, this would introduce moral hazard.
    Keywords: bank failures, contagion, Financial Regulation
    JEL: G01 G21 G28
    Date: 2020–06
  17. By: Samuel J. Ferguson
    Abstract: We model the quantities appearing in Internal Revenue Service (IRS) tax guidance for calculating the health insurance premium tax credit created by the Patient Protection and Affordable Care Act, also called Obamacare. We ask the question of whether there is a procedure, computable by hand, which can calculate the appropriate premium tax credit for any household with self-employment income. We motivate current IRS tax guidance, which has had self-employed taxpayers use a fixed point iteration to calculate their premium tax credits since 2014. Then, we give an example showing that the IRS iteration can lead to a divergent sequence of iterates. As a consequence, IRS guidance does not calculate appropriate premium tax credits for tax returns in certain income intervals, adversely affecting eligible beneficiaries. A bisection procedure for calculating premium tax credits is proposed. We prove that this procedure calculates appropriate premium tax credits for a model of simple tax returns. This is generalized to the case where premium tax credits are received in advance, which is the most common one in applications. We outline the problem of calculating appropriate premium tax credits for models of general tax returns. While the bisection procedure will work with the tax code in its current configuration, it could fail, eg, in states which have not expanded Medicaid, if a new deduction with certain properties were to arise.
    Date: 2020–08
  18. By: Anek Belbase; Laura D. Quinby
    Abstract: Roughly one in four state and local government workers are not covered by Social Security and, unless they have a sufficient work history in the private sector, will rely solely on their employer for pensions and disability insurance. An important question is how these employer-provided benefits compare to the benefits that these workers might have received through Social Security. In other words, do workers who are outside of the Social Security system receive an adequate level of protection against old-age poverty and long-term disability? While prior work has examined the adequacy of pension benefits for workers who are not covered by Social Security, little is known about the disability insurance (DI) that these workers receive. This brief fills the gap by analyzing the rules governing DI benefits in 67 state and local programs (referred to as ÒSocial Security-replacementÓ programs), which encompass around 70 percent of all uncovered public sector workers. The discussion proceeds as follows. The first section provides background on Social Security disability insurance (SSDI) benefits and the types of state and local workers who are not covered by the program. The second section describes a new dataset of state and local DI programs for uncovered workers that was created for this study. The third section uses this dataset to compare eligibility requirements across state and local programs with those of SSDI, while the fourth section analyzes how benefit levels may differ for eligible workers. The last section concludes that state and local DI programs provide relatively generous protection to older workers who are most at risk of experiencing a disability. Specifically, state and local eligibility requirements are less strict than SSDI, and most long-tenured employees earn higher replacement rates.
    Date: 2020–08
  19. By: Romain Gauchon (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon); Stéphane Loisel (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon); Jean-Louis Rullière (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon)
    Abstract: On paper, prevention appears to be a good complement to health insurance. However, its implementation is often costly. To maximize the impact and efficiency of prevention plans these should target particular groups of policyholders. In this article, we propose a way of clustering policyholders that could be a starting point for the targeting of prevention plans. This two-step method mainly classifies using policyholder health consumption. This dimension is first reduced using a Nonnegative matrix factorization algorithm, producing intermediate health-product clusters. We then cluster using Kohonen's map algorithm. This leads to a natural visualization of the results, allowing the simple comparison of results from different databases. We apply our method to two real health-insurer datasets. We carry out a number of tests (including tests on a text-mining database) of method stability and clustering ability. The method is shown to be stable, easily-understandable, and able to cluster most policyholders efficiently.
    Keywords: Kohonen self-organizing map,Prevention,Non negative Matrix Factorization NMF,Health insurance claims databases,Clustering Algorithm
    Date: 2020
  20. By: Eckhard Platen (Finance Discipline Group, UTS Business School, University of Technology Sydney)
    Abstract: The need for the management of risks related to the COVID-19 epidemic in health, economics, finance and insurance became obvious after its outbreak. As a basis for respective quantitative methods, the paper models in a novel manner the dynamics of an epidemic via a four-dimensional stochastic differential equation. Crucial time dependent input parameters include the reproduction number, the average number of externally new infected and the average number of new vaccinations. The proposed model is driven by a single Brownian motion. When fitted to COVID-19 data it generates the typically observed features. In particular, it captures widely noticed fluctuations in the number of newly infected. Fundamental probabilistic properties of the dynamics of an epidemic can be deduced from the proposed model. These form a basis for managing successfully an epidemic and related economic and financial risks. As a general tool for quantitative studies a simulation algorithm is provided. A case study illustrates the model and discusses strategies for reopening the Australian economy during the COVID-19 epidemic.
    Keywords: stochastic epidemic model; stochastic differential equations; squared Bessel process, COVID-19 epidemic; simulation
    Date: 2020–04–01
  21. By: Weihong Ni (ICJ, PSPM); Corina Constantinescu (ICJ, PSPM); Alfredo Eg\'idio dos Reis (ICJ, PSPM); V\'eronique Maume-Deschamps (ICJ, PSPM)
    Abstract: In this manuscript we propose a method for pricing insurance products that cover not only traditional risks, but also unforeseen ones. By considering the Poisson process parameter to be a mixed random variable, we capture the heterogeneity of foreseeable and unforeseeable risks. To illustrate, we estimate the weights for the two risk streams for a real dataset from a Portuguese insurer. To calculate the premium, we set the frequency and severity as distributions that belong to the linear exponential family. Under a Bayesian setup , we show that when working with a finite mixture of conjugate priors, the premium can be estimated by a mixture of posterior means, with updated parameters, depending on claim histories. We emphasise the riskiness of the unforeseeable trend, by choosing heavy-tailed distributions. After estimating distribution parameters involved using the Expectation-Maximization algorithm, we found that Bayesian premiums derived are more reactive to claim trends than traditional ones.
    Date: 2020–07
  22. By: International Monetary Fund
    Abstract: This Technical Assistance (TA) report focuses the compilation of financial soundness indicators (FSI) for the deposit takers (DTs), which cover 15 commercial banks, using the chart of accounts (COAs) and supervisory series as source data. The regulatory and accounting practices of the DTs are broadly in line with the FSI Guide, which defers to Basel principles and International Accounting Standards. The mission recommended an action plan with the following priority recommendations to support progress in the FSI compilation. The mission highlighted the need to complement the FSI data with the corresponding metadata. Metadata should also contain information on the content and coverage of the FSIs, as well as the accounting conventions and other national guidelines. As the financial performance of commercial banks’ counterpart sectors as well as key markets has direct impact on the soundness of the financial sector, it is recommended to coordinate with regulators of other financial institutions that are not under the Central Bank of Montenegro’s supervision to draw a work program to collect data for compiling FSIs for other financial corporations.
    Keywords: External sector statistics;Systemic risk assessment;Insurance companies investments;Financial statistics;Pension funds;FSI,DTs,source data,CBM,FSD
    Date: 2019–03–14
  23. By: Rajashri Chakrabarti
    Abstract: Average economic outcomes serve as important indicators of the overall state of the economy. However, they mask a lot of underlying variability in how people experience the economy across geography, or by race, income, age, or other attributes. Following our series on heterogeneity broadly in October 2019 and in labor market outcomes in March 2020, we now turn our focus to further documenting heterogeneity in the credit market. While we have written about credit market heterogeneity before, this series integrates insights on disparities in outcomes in various parts of the credit market. The analysis includes a look at differing homeownership rates across populations, varying exposure to foreclosures and evictions, and uneven student loan burdens and repayment behaviors. It also covers heterogeneous effects of policies by comparing financial health outcomes for those with access to public tuition subsidies and Medicare versus those not eligible. The findings underscore that a measure of the average, particularly relating to policy impact, is far from complete. Rather, a sharper picture of the diverse effects is essential to understanding the efficacy of policy.
    Keywords: student debt; housing; mortgage; medicare
    JEL: Q12 R31 I24
    Date: 2020–07–07
  24. By: Victor Amoureux; Elvire Guillaud; Michaël Zemmour
    Abstract: The literature on tax systems generally considers each type of tax in a self-contained way, with its own distributive characteristics. While the income tax is considered as a progressive tax, social insurance contributions are seen as being regressive, namely because of ceilings. Using a database of comparative micro-data at the household level (LIS data, 22 OECD countries, 1999-2016 period), supplemented with OECD data on employer contributions, we measure effective tax rates over the entire income distribution. Our results jeopardize the conventional economic wisdom on the role of income and payroll taxes in tax progressivity, and on their respective impact on inequality reduction. We show that, in all countries of our sample, the progressivity of income tax increases as soon as the progressivity of social insurance contributions decreases. This implies that income and payroll tax schedules are not independent. Even more, they act in a complementary way. While payroll tax heavily compress inequalities at the bottom of the income distribution, income tax reduces inequalities at the top.
    JEL: D31 H30 I38
    Date: 2019–10
  25. By: Deborah Peikes; Grace Anglin; Janice Genevro; et al.
    Abstract: The Findings at a Glance provides a brief overview of key findings from the independent evaluation of the first two years of CPC+, for practices that began the model in 2017.
    Keywords: primary care, comprehensive primary care, healthcare payment reform, Medicare, CMMI, CPC+, evaluation
  26. By: Mamadou Saliou Balde (Université Félix Houphouët-Boigny d’Abidjan-Cocody - Université Félix Houphouët-Boigny d’Abidjan-Cocody - Université Félix Houphouët-Boigny d’Abidjan-Cocody); Balde Saliou
    Abstract: Des objectifs du millénaire pour le développement (OMD) aux objectifs de développement durable (ODD), la santé maternelle occupe une place importante. En Guinée, la situation sanitaire des femmes enceintes demeure une préoccupation majeure. En effet, le taux de mortalité maternelle se situait à 576 décès maternels pour 100 000 naissances vivantes en 2017. Les principales causes de cette mortalité maternelle élevée est la nonutilisation adéquate des services de soins prénatals ou l'absence d'assistance médicale à l'accouchement. L'objectif de cette étude est d'identifier les déterminants de la demande de soins prénatals, et de voir l'effet de ces soins sur l'accouchement assisté. Pour ce faire, les données utilisées sont celles de l'enquête démographique et de santé (EDS V). Elle a été conduite par l'institut national de la statistique (INS) avec l'assistance technique de la société ICF international. Cette étude utilise un modèle négatif binomial pour identifier les déterminants de la demande de soins prénatals, et une régression logistique pour voir l'effet de ces soins sur l'accouchement assisté. Les résultats montrent que les déterminants de la demande de soins prénatals sont : le niveau de vie du ménage, l'instruction de la femme et de son conjoint, le milieu de résidence, l'exposition de la femme à la télévision et la souscription à une assurance. Aussi, ils confirment l'effet positif des soins prénatals sur le recours à l'accouchement assisté. L'étude recommande la sensibilisation sur les avantages de la consultation prénatale et l'accouchement assisté sur la réduction de la morbidité et la mortalité maternelle. Aussi, la gratuité des consultations prénatales et la réduction des frais d'accouchement afin d'augmenter leurs utilisations.
    Keywords: Prenatal healthcare,assisted delivery,Negative binomial,Guinea
    Date: 2020–06–30

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