Malaria and Economic Development

Malaria tends to have a negative correlation with national income per capita. Many existing studies emphasize how falling rates of malaria can enhance economic development due to the beneficial effect on human capital. This paper emphasizes that causality may also run in the opposite direction, in particular, that higher incomes—arising for reasons having nothing to do with human capital—may allow for increased prevention and treatment of malaria, and therefore contribute to the negative correlation. We analyze the malaria‐income relationship for 100 endemic countries over a 17‐year period using a simultaneous equations model that accounts for reverse causality and incidental associations. For most countries, income growth has been the most important driver of the negative correlation between malaria and income. Although reducing malaria may be its own reward, it takes much more than reductions in malaria to foster development. This holds widely for different samples of countries.     

Price Discrimination in Public Healthcare

Could a public healthcare system use price discrimination—paying medical service providers different fees, depending on the service provider's quality—lead to improvements in social welfare? We show that differentiating medical fees by quality increases social welfare relative to uniform pricing (i.e. quality‐invariant fee schedules) whenever hospitals and doctors have private information about their own ability. We also show that by moving from uniform to differentiated medical fees, the public healthcare system can effectively incentivise good doctors and hospitals (i.e. low‐cost‐types) to provide even higher levels of quality than they would under complete information. In the socially optimal quality‐differentiated medical fee system, low‐cost‐type medical‐service providers enjoy a rent due to their informational advantage. Informational rent is socially beneficial because it gives service providers a strong incentive to invest in the extra training required to deliver high‐quality services at low cost, providing yet another efficiency gain from quality‐differentiated medical fees.     

DO HEALTH INSURERS CONTRACT THE BEST PROVIDERS? PROVIDER NETWORKS,QUALITY, AND COSTS

We provide a modeling framework to analyze selective contracting in the health‐care sector. Two health‐care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider quality through their choice of provider network. Selective contracting focuses on low‐cost providers. Contracting both providers signals high quality. Market power reduces the scope for signaling, thereby leading to lower quality and inefficiency.     

EXPERIMENTAL AND SELF‐REPORTED MEASURES OF RISK TAKING AND DIGIT RATIO (2D:4D): EVIDENCE FROM A LARGE,SYSTEMATIC STUDY

We systematically investigate the links between the digit ratio (2D:4D)—a biomarker for prenatal testosterone exposure—and two measures of individual risk taking: (i) risk preferences (RP) over lotteries with real monetary incentives and (ii) self‐reported risk attitude (RA). We find that both the right‐hand and the left‐hand digit ratio are significantly associated with RP: Subjects with lower digit ratios tend to choose riskier lotteries. Neither digit ratio, however, is associated with self‐reported RA.     

NEW FORMS OF PROVIDER IN THE ENGLISH NATIONAL HEALTH SERVICE

ABSTRACT 1 : A wide ranging set of reforms is being introduced into the English National Health Service (NHS). They are designed to increase the market‐like behaviour of providers of care with a view to improving efficiency, quality and responsiveness of services. This paper is concerned with one aspect of those reforms: namely the policy to increase the diversity of types of providers of care to NHS patients. In this context, increasing diversity means that providers will not all be standard publicly owned NHS organizations. They can be publicly owned but autonomous, or independent (both in for‐profit and not for profit). The paper discusses the wide range of organizational forms available, analyzing their governance structures It then discusses the small amount of evidence currently available about the performance of diverse providers of health care.     

Can individuals’ beliefs help us understand nonadherence to malaria test results? Evidence from rural Kenya

In malaria‐endemic countries about a quarter of test‐negative individuals take antimalarials (artemisinin‐based combination therapies [ACTs]). ACT overuse depletes scarce resources for subsidies and contributes to parasite resistance. As part of an experiment in Kenya that provided subsidies for rapid diagnostic test and/or for ACTs conditionally on being positive, we studied the association between beliefs on malaria status (prior and posterior the intervention) and decisions to get tested and to purchase ACTs. We find that prior beliefs do not explain the decision of getting tested (conditional on the price) and nonadherence to a negative test. However, test‐negative individuals who purchase ACTs report higher posterior beliefs than those who do not, consistent with a framework in which the formers revise beliefs upward, while the latters do not change or revise downward. We also do not find evidence that prior beliefs on ACT effectiveness and trust in test results play any major role in explaining testing or treatment behavior. Further research is needed to improve adherence to malaria‐negative test results.     

Delivering Public Health Care Services: Substitutes,Complements, or Both?

In this article we investigate how the availability of public health care providers increases (complement) or decreases (substitute) the likelihood of having public or private health insurance. The probability of each of three insurance alternatives (uninsured, Medicaid, private insurance) is modeled as a function of the availability of public programs in the respondents'community along with individual characteristics including family income, health status, and family structure. Using population-based estimates, public hospitals are associated with a crowd-out rate of 3.5 percent to 8.6 percent. Federally qualified health centers were associated with a net complementary effect (additional public insurance take-up) of 7.1 percent. (JEL I11 , I18 , I38 )     

Parents,migrant domestic workers and children's speaking of a second language: Evidence from Hong Kong

This paper explores the effects of different language home environments provided by English‐speaking and non‐English‐speaking migrant domestic workers (MDW) on Hong Kong children's ability to speak English. Results show that English‐speaking MDW in working‐mother households increase children's likelihood of speaking English by 12% if the mother in the household does not speak English but by 25% if the mother in the household is capable of speaking English. Non‐English‐speaking MDW, however, are found to have little such effects. Age and education are two qualities of English‐speaking MDW that are significantly associated with improvements in children's English‐speaking ability and their English school subject.     

Can social spending cushion the inequality effect of globalization?

This paper examines whether social spending cushions the effect of globalization on within‐country inequality. Using information on disposable and market income inequality and data on overall social spending, and health and education spending from the ILO and the World Bank/WHO, we analyze whether social spending moderates the association between economic globalization and inequality. The results confirm that economic globalization—especially economic flows—associates with higher income inequality, an effect driven by non‐OECD countries. Health spending is strongly associated with lower inequality, but we find no robust evidence that any kind of social spending negatively moderates the association between economic globalization and inequality.     

The associations between early life circumstances and later life health and employment in Europe

We use data from the Survey of Health, Aging, and Retirement in Europe to estimate for thirteen European countries the associations of early life circumstances—measured by childhood health and socioeconomic status (SES)—with educational attainment, and later life health and employment (at ages 50–64). In all countries and for men and women, favorable early life circumstances, and in particular a higher childhood SES, are associated with a higher level of education. In most countries and in particular for women, favorable early life circumstances are associated with better later life health, also when education is controlled for. The significant associations of favorable early life circumstances with a higher incidence of later life employment are mostly transmitted through education and later life health.     

Early Warning for Currency Crises: What Is the Role of Financial Openness?

The paper explores whether financial openness—capital account openness and gross capital inflows—makes countries vulnerable to currency crises. A quarterly dataset on 46 advanced and emerging market economies (AEs and EMEs) during 1975Q1–2011Q4 is used, with the period after Q2 2007 used for out‐of‐sample testing. The key findings are: (1) capital account openness is associated with lower probability of currency crises, but less so for EMEs; (2) surges in gross capital flows are associated with increased risk of currency crises; and (3) the model performs well out‐of‐sample, confirming that early warning models are helpful in judging relative vulnerability.     

TESTING THE BAUMOL–NORDHAUS MODEL WITH EU KLEMS DATA

Baumol's (1967 ) seminal model of structural change predicts that large service industries financed mainly through taxes and social contributions—like health care and education, for instance—will acquire ever‐larger shares of total expenditures and that, concomitantly, overall productivity growth will decline. Applying a new testing strategy for Baumol's model, Nordhaus (2008 ) finds strong evidence in favor of the “cost and growth diseases” in U.S. GDP‐by‐industry data (published by the Department of Commerce's Bureau of Economic Analysis). The aim of the present paper is twofold. The first is to check whether Nordhaus's results can be reproduced using U.S. industry data from the EU KLEMS database. Second, Nordhaus's testing methodology is applied to European Union data from the same database. The results suggest that—although there are differences vis‐à‐vis the U.S.—the EU also shows symptoms of “Baumol's diseases.”     

Non‐Linear Pricing and Price Indexes: Evidence and Implications from Scanner Data

Non‐linear pricing, the fact that prices do not necessarily change in proportion to size, is a ubiquitous phenomenon. However, it has been neither particularly well understood nor well measured. Non‐linear pricing is of practical importance for statistical agencies who, in constructing price indexes, are often required to compare the relative price of a product‐variety of two different sizes. It is usually assumed that prices change one‐for‐one with package and pack size (e.g. a 1‐liter cola costs half as much as a 2‐liter bottle). We question the wisdom of such an assumption and outline a model to flexibly estimate the price‐size function. Applying our model to a large U.S. scanner dataset for carbonated beverages, at a disaggregated level, we find very significant discounts for larger‐sized products. This highlights the need to pursue methods such as those advocated in this paper.     

Outcomes from use of an evidence-based practice guideline

The aim of evidence-based guidelines is primarily to improve patient outcomes without adding to the existing cost of care because both payers and policymakers want to identify health care costs that do not result in benefit to the patient. The purpose of the reported project was to generate a practice guideline for the treatment of uncomplicated acute cystitis in a female population, to determine the extent to which the guideline would be used by providers and to measure the cost and quality of outcomes from its use. A retrospective chart review was used to gather pre-guideline practice and cost data. Measurements included the type, frequency, and duration of antibiotic therapy and the use of urine cultures and both complications and routine followup visits. The implementation of an outpatient practice guideline resulted in a significant change in antibiotic prescribing and a trend toward a change in ordering cultures and clinic followup. There was also a significant decrease in treatment costs.     

Joint Production of Food and Wildlife: Uniform Measures or Nature Oases?

Intensive agriculture is often bad for wildlife. Does this imply that a goal to boost wildlife on agricultural land is best met through a general reduction in intensity? We argue that such an approach may not be optimal, since cost functions for provision of wildlife on agricultural land may be non-convex, due to fixed costs associated with such provision. This implies that, even when farms are identical, it may be preferable to split them into groups of high providers and low providers. We test our hypothesis in a study of the optimal management of mown grasslands in southern Sweden, where the two products are silage and successful reproduction of ground-nesting birds, and the variable controlled by the farmer is the date of the first mowing. We show that the optimal solution is likely to involve some farmers maintaining profit-maximizing practices while other—identical—farmers delay their first mowing significantly. The superiority of such split solutions may have major implications for agricultural policy.     

Counting the uncounted: The consequences of children's domestic chores for health and education in Ethiopia

Much of the existing literature on the economics of child labor assumes that child labor is synonymous with employment in income‐generating activities. However, children also perform domestic chores, and excessive involvement in chores may be detrimental to their wellbeing. This paper investigates the effect on child health and education outcomes of participation in domestic chores as well as participation in income‐generating activities. Our data come from the 2014 Young Lives survey of Ethiopia. We use the guidelines of the 18th International Conference of Labor Statisticians and the United Nations Children's Fund to make a distinction between light work and harmful work, and apply this distinction to both domestic chores and income‐generating work. Using an instrumental variables approach, we find that involvement in harmful domestic chores is strongly associated with poor health and education outcomes. Our findings suggest that excessive involvement in domestic chores constitutes a form of child labor. Ignoring domestic chores will lead to an underestimate of the prevalence of child labor, especially among girls, whose exposure to chores is much higher, on average, than that of boys.     

The role of e-Health in the changng health care environment

In 2005 health care organizations spent 2.3% of total operating expenses on information technology and are slowly developing the infrastructure necessary to expand e-Health capabilities. E-Health is being recognized as a method to improve the overall health status of the population. It is important to build partnerships among health care providers, local community organizations, and national health care associations to ensure the continued development of e-Health initiatives. This study has managerial implications associated with the strategic application of e-Health systems and policy implications on future resource allocation.     

International Technology Transfer and Welfare

We investigate the welfare effect of international technology transfer in a quality model. A foreign innovator with a new quality product can license its innovation to the domestic firm(s) via a fixed fee. Findings show that the foreign innovator will license exclusively to the high‐quality firm under Bertrand competition, whereas it may exclusively license to the high‐quality firm, the low‐quality firm, or non‐exclusively to both firms under Cournot competition. Non‐exclusive licensing is necessarily welfare‐enhancing whereas exclusive licensing is welfare‐reducing if the quality of the new technology is not sufficiently superior to that of the domestic ones.     

Do Your Neighbors Influence Your Health?

When individuals make decisions regarding their allocation of time and income, the health investment and health that they achieve may fall short of the goals prescribed by medical guidelines and health policymakers. Instead of the oft‐observed policy responses such as additional spending on public awareness campaigns, it may be more fruitful to determine how individuals can be induced to choose behaviors that will lead to the prescribed health. That is, one must recognize the trade‐offs between health investment and consumption or leisure today in the face of factors such as social norms, job stress and advances in health technology.