[Show abstract][Hide abstract] ABSTRACT: Informal health providers ranging from drug vendors to traditional healers account for a
large fraction of health care consumption in developing countries. They are, however, largely
unlicensed and unregulated leading to concern that they provide ineffective and, in some cases,
even harmful care. A new and controversial policy tool that has been proposed to alter household
health seeking behavior is an outright ban on these informal providers. The theoretical effects of
such a ban are ambiguous. In this paper, we study the effect of a ban on informal (traditional)
birth attendants imposed by the Malawi government in 2007. To measure the effect of the
ban, we exploit variation across time and space in the intensity of exposure to the ban i.e., a
difference-in-difference strategy. Our most conservative estimates suggest that the ban decreased
use of traditional attendants by about 15 percentage points. Consistent with policy objectives,
the ban shifted births to the formal sector, increasing use of formal sector providers by about 10
percentage points. The rest of the decrease is accounted for by an increase in the use of other
informal substitutes, primarily relative-attended births. Despite the rather large shift from the
informal to the formal sector, we find no evidence of a reduction in newborn deaths. This result
is consistent with recent studies that argue that increasing the use of formal sector providers is,
by itself, unlikely to result in significant improvements in health outcomes.
[Show abstract][Hide abstract] ABSTRACT: Can pro-social preferences lead to dishonest or unethical behavior? Lab evidence suggests that it can. In this paper, we document some of the first field evidence of this phenomenon. In this study, individuals were hired as field sta? and tasked with distributing subsidized price vouchers following a clearly specified protocol. We find substantial deviation from the protocol, i.e., cheating. We study the mis-allocation of the vouchers to gain some insight into motivations for dishonesty. In our main result we find that the field sta? were significantly more likely to allocate the higher value vouchers (those representing a greater subsidy) to the poorest beneficiaries. While we are not able to definitively establish the motivations for this observed pro-social behavior, we argue that this result is consistent with a model of social preferences and less consistent with a pure self- interest motive.
[Show abstract][Hide abstract] ABSTRACT: Health worker migration is an issue of first order concern in global health policy circles and continues to be the subject of much policy debate. In this paper, we contribute to the discussion by studying the impact of economic conditions on the migration of physicians from developing countries. To our knowledge, this is one of the first papers to do so. A major contribution of this paper is the introduction of a new panel dataset on migration to the US and the UK from 31 sub-Saharan Africa countries. The data spans the period 1975–2004. Using this data, we estimate the impact of changes in economic conditions on physician migration. In our preferred specification that allows for country-specific time trends, we find that a temporary one percentage point decline in GDP per capita increases physician migration in the next period by approximately .3 percent. In our IV models a one percentage point decline in GDP per capita increases physician migration in the next period by between 3.4 and 3.6 percent. Overall, our results suggest a significant effect of developing country economic conditions on physician migration.
Social Science [?] Medicine 12/2013; 98:169–178. DOI:10.1016/j.socscimed.2013.09.010 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increased access to antiretroviral therapy (ART) in developing countries over the last decade is believed to have contributed to reductions in HIV transmission and improvements in life expectancy. While numerous studies document the effects of ART on physical health and functioning, comparatively less attention has been paid to the effects of ART on mental health outcomes. In this paper we study the impact of ART on depression in a cohort of patients in Uganda entering HIV care. We find that 12 months after beginning ART, the prevalence of major and minor depression in the treatment group had fallen by approximately 15 and 27 percentage points respectively relative to a comparison group of patients in HIV care but not receiving ART. We also find some evidence that ART helps to close the well-known gender gap in depression between men and women.
Social Science [?] Medicine 09/2013; 92C:27-34. DOI:10.1016/j.socscimed.2013.05.018 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is believed that low wages are an important reason why doctors and nurses in developing countries migrate, and this has
led to a call for higher wages for health professionals in developing countries. In this paper, we provide some of the first
estimates of the impact of raising health workers’ salaries on migration. Using aggregate panel data on the stock of foreign
doctors in 16 Organization for Economic Cooperation and Development countries, we explore the effect of a wage increase programme
in Ghana on physician migration. We find evidence that 6 years after the implementation of this programme, the foreign stock
of Ghanaian doctors abroad had fallen by approximately 10% relative to the estimated counterfactual. This result should be
interpreted with caution, however, given the sensitivity of the results to changes in model specification.
Health Policy and Planning 07/2013; 29(5). DOI:10.1093/heapol/czt046 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: How does increasing access to treatment affect the demand for preventive testing? In this paper we present results from a field experiment in Nigeria in which we offered cervical cancer screening to women at randomly chosen prices. To test our hypothesis, we also offered women a lottery where the payoff was a subsidy towards the cost of cervical cancer treatment (conditional upon a diagnosis of cervical cancer). We find that women randomly selected to receive the conditional cancer treatment subsidy were about 4 percentage points more likely to take up screening than those in the control group. We also show that reducing the price of screening by 10 cents increased take-up by about 1 percentage point. These results offer compelling evidence that the optimal set of subsidies to increase take-up of preventive testing in developing countries, must include subsidies towards treatment costs (in addition to price subsidies).
Journal of Health Economics 10/2012; 32(1):207-218. DOI:10.1016/j.jhealeco.2012.10.001 · 2.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: How does increasing access to treatment affect the demand for preventive testing? In this paper we present results from a randomized field experiment in Nigeria in which we offered cervical cancer screening to women at randomly chosen prices. To test our hypothesis, we also offered women a lottery where the payoff was a subsidy towards the cost of cervical cancer treatment (conditional upon a diagnosis of cervical cancer). We find that women randomly selected to receive the conditional cancer treatment subsidy were about 4 percentage points more likely to take up screening than those in the control group (an approximately 30% increase). We also show that the price of screening had a significant effect on the demand for screening: reducing the price of screening by 10 cents increased take-up of screening by about 1 percentage point (an approximately 7% increase).
[Show abstract][Hide abstract] ABSTRACT: It is widely believed that poor economic conditions in developing countries contribute to the migration of health professionals. In this paper we test this hypothesis using new panel data on the annual flow of physicians from 31 African countries to the United States and the United Kingdom. The data spans the period 1975-2004. Using a variety of fixed effects and instrumental variable models, we show that economic shocks have a statistically significant impact on the migration of physicians. Results from the fixed effects models suggest that a one-percentage point decline in lagged economic growth increases physician migration in year t by approximately 0.3 percent. The IV estimates are several orders of magnitude larger implying that a one percentage point decline in economic growth in t − 1 causes an increase in physician migration in year t of between 3.4 and 3.6 percent.
[Show abstract][Hide abstract] ABSTRACT: Surveys of health professionals in developing countries routinely mention low salaries as an important reason for migration. As a result, many have called for the salaries of health professionals in developing countries to be increased. Yet the extent to which higher salaries reduce migration remains unclear. In this paper we provide some of the first estimates of the impact of raising health workers salaries on migration. We exploit the variation created by a large-scale policy experiment in Ghana and use this to identify the causal effect of doctors salaries on migration. Using innovative new methods developed by (Abadie et al., 2010) to construct the counterfactual, we find some evidence that a salary increase program for doctors instituted by the Ghanaian government in 1998 led to a reduction in the migration of doctors. In our main specification we find that six years after the implementation of this program, the foreign stock of Ghanaian doctors abroad had fallen by approximately 91 physicians relative to what it would have been without the program. This translates to roughly a 10 percent decrease in migration.
[Show abstract][Hide abstract] ABSTRACT: We revisit the question of price elasticity of employer-sponsored insurance (ESI) take-up by directly examining changes in the take-up of ESI at a large firm in response to exogenous changes in employee premium contributions. We find that, on average, a 10% increase in the employee's out-of-pocket premium increases the probability of dropping coverage by approximately 1%. More importantly, we find heterogeneous impacts: married workers are much more price-sensitive than single employees, and lower-paid workers are disproportionately more likely to drop coverage than higher-paid workers. Elasticity estimates for employees below the 25th percentile of salary distribution in our sample are nearly twice the average.
Inquiry: a journal of medical care organization, provision and financing 03/2010; 47(1):33-47. DOI:10.2307/23035595 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While early growth in preferred provider organizations (PPOs) coincided with growth of managed care generally, recent expansion has come primarily at the expense of other managed care plans. Little is known about the micro behavior underlying these trends. In 2005, University of Michigan employees were offered PPOs for the first time by vendors who also offered other plans. PPOs helped the offering vendors maintain or increase their total enrollment share. PPOs were most attractive to workers who previously had chosen less managed plans. Because PPOs drew few enrollees from health maintenance organizations (HMOs), there was little evidence of a backlash against managed care in the context of the University of Michigan employee group.
Inquiry: a journal of medical care organization, provision and financing 12/2007; 44(4):400-11. DOI:10.5034/inquiryjrnl_44.4.400 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract In response to major challenges in the recruitment and retention of doctors in Ghana, the Ghanaian Federal Government in 1998 instituted a scheme known as the Additional Duty Hours Allowance (ADHA) Scheme. The ADHA scheme was a salary support program meant to compensate doctors for additional hours worked. Even though precise estimates are hard to come by, several reports suggest that the ADHA scheme had a significant impact on doctors’ incomes increasing it by between 75-150 percent. In this paper I exploit this natural experiment to identify the causal impact of wages on physician emigration. Using the synthetic control method,developed by Abadie et al. (2007) and applying it to data on physician migration collected by Docquier et al. (2007), I find that the ADHA program reduced the emigration of doctors from Ghana. By 2004, six years after the program was implemented, there were approximately 100 fewer doctors abroad than would have been the case without the program. This translates to an approximately 17 percent decrease relative to the mean foreign stock of Ghanaian doctors and a 7 percent decrease relative to the mean domestic stock. 1 INTRODUCTION,1