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Luo Y, Zhou L, Zhang W. Help or Hurt? The Impact of Digital Finance on the Physical Health of the Elderly in China. Healthcare (Basel) 2024; 12:1299. [PMID: 38998834 PMCID: PMC11241007 DOI: 10.3390/healthcare12131299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Under the backdrop of global aging, the escalating number of elderly individuals in poor health poses a growing social burden and impacts economic development and social stability. A fundamental question arises as to whether the advancements of digital finance (DF) can effectively enhance the physical health of the elderly. This study aims to investigate the impact of DF on the physical health of the elderly by utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013, 2015, and 2018. The results reveal a significant positive impact of DF on enhancing the physical health of the elderly. Furthermore, the study demonstrates that this impact is particularly pronounced among the elderly with higher educational attainment, stronger intergenerational links, and those residing in central cities. A mechanism analysis further reveals that DF contributes to improving the physical health of the elderly by augmenting household disposable income, alleviating liquidity constraints, and enhancing the utilization of medical services. These findings offer valuable insights for the future development of DF and the implementation of policies promoting healthy aging and active aging.
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Affiliation(s)
- Yaling Luo
- School of Public Administration, Sichuan University, Chengdu 610041, China
| | - Lei Zhou
- School of Public Administration, Sichuan University, Chengdu 610041, China
| | - Weike Zhang
- School of Public Administration, Sichuan University, Chengdu 610041, China
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2
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Jung D, Kim B. The effect of health facility births on newborn mortality in Malawi. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023:10.1007/s10754-023-09348-x. [PMID: 37010654 DOI: 10.1007/s10754-023-09348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
We examine the effect of health facility delivery on newborn mortality in Malawi using data from a survey of mothers in the Chimutu district, Malawi. The study exploits labour contraction time as an instrumental variable to overcome endogeneity of health facility delivery. The results show that health facility delivery does not reduce 7-day and 28-day mortality rates. In a low-income country like Malawi where the healthcare quality is severely compromised, we conclude that encouraging health facility delivery may not guarantee positive health outcomes for newborn births.
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Affiliation(s)
- Dawoon Jung
- Korea Institute of Public Finance, Sejong, Republic of Korea
| | - Booyuel Kim
- Department of Environmental Planning, Graduate School of Environmental Studies, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Buffie EF, Adam C, Zanna LF, Kpodar K. Loss-of-learning and the post-Covid recovery in low-income countries. JOURNAL OF MACROECONOMICS 2023; 75:103492. [PMID: 36591598 PMCID: PMC9788846 DOI: 10.1016/j.jmacro.2022.103492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
We analyze the medium-term macroeconomic impact of the Covid-19 pandemic and associated lock-down measures on low-income countries. We focus on the impact of the degradation of health and human capital caused by the pandemic and its aftermath, exploring the trade-offs between rebuilding human capital and the recovery of livelihoods and macroeconomic sustainability. A dynamic general equilibrium model is calibrated to reflect the structural characteristics of vulnerable low-income countries and to replicate key dimensions of the Covid-19 shock. We show that absent significant and sustained external financing, the persistence of loss-of-learning effects on labor productivity is likely to make the post-Covid recovery more attenuated and more expensive than many contemporary analysis suggests.
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Affiliation(s)
- Edward F Buffie
- Department of Economics, Indiana University, United States of America
| | - Christopher Adam
- Department of International Development, University of Oxford, United Kingdom
| | - Luis-Felipe Zanna
- Institute for Capacity Development, International Monetary Fund, United States of America
| | - Kangni Kpodar
- Strategy, Policy, and Review Department, International Monetary Fund, United States of America; FERDI, France
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Opoku Duku SK, Nketiah‐Amponsah E, Fenenga CJ, Janssens W, Pradhan M. The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment. HEALTH ECONOMICS 2022; 31:2120-2141. [PMID: 35944042 PMCID: PMC9545140 DOI: 10.1002/hec.4556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/05/2021] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Health insurance enrollment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical-technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.
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Affiliation(s)
| | | | - Christine J. Fenenga
- Department of Health ScienceUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Wendy Janssens
- Vrije Universiteit (VU) Amsterdam and Amsterdam Institute of Global Health and Development (AIGHD)AmsterdamThe Netherlands
| | - Menno Pradhan
- Vrije Universiteit (VU) AmsterdamUniveristy of Amsterdam and Amsterdam Institute of Global Health and Development (AIGHD)AmsterdamThe Netherlands
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Francetic I, Fink G, Tediosi F. Impact of social accountability monitoring on health facility performance: Evidence from Tanzania. HEALTH ECONOMICS 2021; 30:766-785. [PMID: 33458910 DOI: 10.1002/hec.4219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Social accountability programs are increasingly used to improve the performance of public service providers in low-income settings. Despite their growing popularity, evidence on the effectiveness of social accountability programs remains mixed. In this manuscript, we assess the impact of a social accountability intervention on health facility management exploring quasiexperimental variation in program exposure in Tanzania. We find that the social accountability intervention resulted in a 1.8 SD reduction in drug stockouts relative to the control group, but did not improve facility infrastructure maintenance. The results of this study suggest that social accountability programs may be effective in areas of health service provision that are responsive to changes in provider behavior but may not work in settings where improvements in outcomes are conditional on larger health systems features.
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Affiliation(s)
- Igor Francetic
- Health Organization, Policy and Economics (HOPE) Group, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Okeke EN, Abubakar IS. Healthcare at the Beginning of Life and Child Survival: Evidence from a Cash Transfer Experiment in Nigeria. JOURNAL OF DEVELOPMENT ECONOMICS 2020; 143:102426. [PMID: 32863533 PMCID: PMC7450787 DOI: 10.1016/j.jdeveco.2019.102426] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Households in poor countries are encouraged (and sometimes coerced) to increase investments in formal health care services during pregnancy and childbirth. Is this good policy? The answer to a large extent depends on its effects on child welfare. We study the effects of a cash transfer program in Nigeria in which households were offered a payment of $14 conditioned on uptake of health services. We show that the transfer led to a large increase in uptake and a substantial increase in child survival driven by a decrease in in-utero child deaths. We present evidence suggesting that the key driver is prenatal health investments.
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Affiliation(s)
- Edward N Okeke
- Department of Economics, Sociology and Statistics, RAND, 1200 South Hayes, Arlington, VA 22202
| | - Isa S Abubakar
- Department of Community Medicine, Bayero University Kano and Aminu Kano Teaching Hospital
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Krystosik AR, Curtis A, Buritica P, Ajayakumar J, Squires R, Dávalos D, Pacheco R, Bhatta MP, James MA. Community context and sub-neighborhood scale detail to explain dengue, chikungunya and Zika patterns in Cali, Colombia. PLoS One 2017; 12:e0181208. [PMID: 28767730 PMCID: PMC5540594 DOI: 10.1371/journal.pone.0181208] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/27/2017] [Indexed: 02/04/2023] Open
Abstract
Background Cali, Colombia has experienced chikungunya and Zika outbreaks and hypoendemic dengue. Studies have explained Cali’s dengue patterns but lack the sub-neighborhood-scale detail investigated here. Methods Spatial-video geonarratives (SVG) with Ministry of Health officials and Community Health Workers were collected in hotspots, providing perspective on perceptions of why dengue, chikungunya and Zika hotspots exist, impediments to control, and social outcomes. Using spatial video and Google Street View, sub-neighborhood features possibly contributing to incidence were mapped to create risk surfaces, later compared with dengue, chikungunya and Zika case data. Results SVG captured insights in 24 neighborhoods. Trash and water risks in Calipso were mapped using SVG results. Perceived risk factors included proximity to standing water, canals, poverty, invasions, localized violence and military migration. These risks overlapped case density maps and identified areas that are suitable for transmission but are possibly underreporting to the surveillance system. Conclusion Resulting risk maps with local context could be leveraged to increase vector-control efficiency- targeting key areas of environmental risk.
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Affiliation(s)
- Amy R. Krystosik
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States of America
- * E-mail:
| | - Andrew Curtis
- Health & Hazards Lab, Department of Geography, Kent State University, Kent, OH, United States of America
| | - Paola Buritica
- Grupo de Investigación en Epidemiología y Servicios (GRIEPIS), Universidad Libre, Cali, Colombia
| | - Jayakrishnan Ajayakumar
- Health & Hazards Lab, Department of Geography, Kent State University, Kent, OH, United States of America
| | - Robert Squires
- Health & Hazards Lab, Department of Geography, Kent State University, Kent, OH, United States of America
| | - Diana Dávalos
- Department of Public Health and Community Medicine, Universidad ICESI, Cali, Valle del Cauca, Colombia
- Center for Clinical Research, Fundación Valle del Lili (FVL), Cali, Valle del Cauca, Colombia
| | - Robinson Pacheco
- Grupo de Investigación en Epidemiología y Servicios (GRIEPIS), Universidad Libre, Cali, Colombia
- Department of Public Health and Community Medicine, Universidad ICESI, Cali, Valle del Cauca, Colombia
- Center for Clinical Research, Fundación Valle del Lili (FVL), Cali, Valle del Cauca, Colombia
| | - Madhav P. Bhatta
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States of America
| | - Mark A. James
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States of America
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Adhvaryu A, Nyshadham A. Health, Enterprise, and Labor Complementarity in the Household. JOURNAL OF DEVELOPMENT ECONOMICS 2017; 126:91-111. [PMID: 28943705 PMCID: PMC5604256 DOI: 10.1016/j.jdeveco.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We study the role of household enterprise as a coping mechanism after health shocks. Using variation in the cost of traveling to formal sector health facilities to predict recovery from acute illness in Tanzania, we show that individuals with prolonged illness switch from farm labor to enterprise activity. This response occurs along both the extensive (entry) and intensive (capital stock and labor supply) margins. Family members who are not ill exhibit exactly the same pattern of responses. Deriving a simple extension to the canonical agricultural household model, we show that our results suggest complementarities in household labor.
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Godlonton S, Okeke EN. Does a ban on informal health providers save lives? Evidence from Malawi. JOURNAL OF DEVELOPMENT ECONOMICS 2016; 118:112-132. [PMID: 26681821 PMCID: PMC4677333 DOI: 10.1016/j.jdeveco.2015.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Informal health providers ranging from drug vendors to traditional healers account for a large fraction of health care provision 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 use a difference-in-difference strategy exploiting variation across time and space in the intensity of exposure to the ban. Our most conservative estimates suggest that the ban decreased use of traditional attendants by about 15 percentage points. Approximately three quarters of this decline can be attributed to an increase in use of the formal sector and the remainder is accounted for by an increase in relative/friend-attended births. Despite the rather large shift from the informal to the formal sector, we do not find any evidence of a statistically significant reduction in newborn mortality on average. The results are robust to a triple difference specification using young children as a control group. We examine several explanations for this result and find evidence consistent with quality of formal care acting as a constraint on improvements in newborn health.
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Adhvaryu A. Learning, Misallocation, and Technology Adoption: Evidence from New Malaria Therapy in Tanzania. ACTA ACUST UNITED AC 2014; 81:1331-1365. [PMID: 25729112 DOI: 10.1093/restud/rdu020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
I study how the misallocation of new technology to individuals who have low ex post returns to its use affects learning and adoption behavior. I focus on antimalarial treatment, which is frequently over-prescribed in many low-income country contexts where diagnostic tests are inaccessible. I show that misdiagnosis reduces average therapeutic effectiveness, because only a fraction of adopters actually have malaria, and slows the rate of social learning due to increased noise. I use data on adoption choices, the timing and duration of fever episodes, and individual blood slide confirmations of malarial status from a pilot study for a new malaria therapy in Tanzania to show that individuals whose reference groups experienced fewer misdiagnoses exhibited stronger learning effects and were more likely to adopt.
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Affiliation(s)
- Achyuta Adhvaryu
- University of Michigan Ross School of Business, , www.achadhvaryu.com
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