The impact of Universal Health Coverage on healthcare consumption and risky behaviours: evidence from Thailand

Thailand is among one of the first non OECD countries to have successfully introduced a form of Universal Health Coverage (UHC) in 2002. This policy defines a natural experiment for the evaluation of the effects of public health insurance on health behaviours. In the present paper, we look at the impact of the Thai UHC on preventive activities, risky behaviours and healthcare consumption using data from the 1996, 2001 and 2003 Health and Welfare Survey of Thailand. We use double robust estimators combining propensity scores and linear regressions to estimate Difference-in-Differences (DD) and Difference in DD (DDD) models. Results offer important insights. First, previously uninsured men and women increased their preventive activities (check-ups) more than any other groups. At the same time, there is no evidence of either an increase in risky behaviours or a reduction of preventive efforts by the newly insured population. In other words, we find no evidence of ex ante moral hazard. Regarding healthcare consumption, we see that hospital admissions increased by 2% and outpatient visits increased by 13% due to the UHC. Overall, these findings imply positive health impacts among the Thai population who entered in the UHC

Empowering girls, delaying marriage: Exploring the role of marital age and education on domestic violence in India

Domestic violence represents the most important component of violence against women. Whilst some literature report female empowerment as a protective factor against domestic violence, some literature find the opposite because the husband may attempt to compensate for the enhanced status of his wife. This paper aims to investigate the effects of female empowerment in the form of marital age and education on domestic violence in India, where intimate partner violence is amongst the highest in Asia. The analysis is based on the sample of eligible women aged 15-49 with valid response on domestic violence in the 2015- 2016 National Family Health Survey (NFHS-4) (n=9722). Upon estimating a series of instrumental variable (IV) regressions using age at menarche as an exogenous and strong instrument, we establish a causal relationship between empowerment and domestic violence taking into account the endogeneity of marital age and education. We further disentangle the relationships between domestic violence and age at marriage and education, separately. In addition, we investigate how maritage age and education influence domestic violence through labour market participation and spouse quality channels. We find that: i) empowered women do experience less domestic violence; ii) marital age and education are partially complementary; iii) labour market participation and spousal quality are relevant mediators of these relationships. Policies aiming at reducing domestic violence in India hence should be holistic, focussing on investing in education both for women and men and improving the conditions of the women’ labour market

News from the front: Estimation of excess mortality and life expectancy in the major epicenters of the COVID-19 pandemic in Italy

Existing studies commonly rely on national official reports to estimate the impact of COVID-19 on human life. This is problematic because classification, estimation and reporting of COVID-19 mortality are not consistent across countries. To overcome these problems, this study exploits all cause daily death registrations data provided by the Italian Statistical Office (ISTAT) from January 1 to April 15, 2020. This allows us to: 1) calculate excess mortality in 2020 compared to the average of the years 2015 to 2019; and 2) estimate life expectancy on a seasonal and annual basis. Focusing on the five most severely hit provinces in Italy (Bergamo, Brescia, Cremona, Lodi and Piacenza) and Lombardy region, this analysis captures the impact of COVID-19 on mortality and life expectancy, which are likely to be underestimated when only national level data are considered. We find that seasonal life expectancy in 2020 in the five provinces reduced by 5.1 to 7.8 and 3.2 to 5.8 years for men and women, respectively. For annual life expectancy for the year 2020, in a scenario with no harvesting effect i.e. mortality rates resume to an average level of the years 2015-2019 after the end of the first epidemic wave, the years of life lost is equivalent to 2 to 3.5 years for men and 1.1. to 2.5 years for women in the five provinces. This represents the largest decline in life expectancy after the 1918 influenza pandemic and the Second World War

Deep-underground search for the decay of 180m-Ta with an ultra-low-background HPGe detector

$^{180m}$Ta is the longest-lived metastable state presently known. Its decay has not been observed yet. In this work, we report a new result on the decay of $^{180m}$Ta obtained with a $2015.12$-g tantalum sample measured for $527.7$ d with an ultra-low background HPGe detector in the STELLA laboratory of the Laboratori Nazionali del Gran Sasso, in Italy. Before the measurement, the sample has been stored deep-underground for ten years, resulting in subdominant background contributions from cosmogenically activated $^{182}$Ta. We observe no signal in the regions of interest and set half-life limits on the process for the two channels EC and $\beta^-$: $T_{1/2,~\mathrm{EC}} > 1.6 \times 10^{18}$ yr and $T_{1/2,~\beta^-} > 1.1\times 10^{18}$ yr ($90$% C. I.), respectively. We also set the limit on the $\gamma$ de-excitation / IC channel: $T_{1/2,~\mathrm{IC}} > 4.1 \times 10^{15}$ yr ($90$% C. I.). These are, as of now, the most stringent bounds on the decay of $^{180m}$Ta worldwide.Comment: 8 pages, 7 figures, 4 table

Human costs of the first wave of the COVID-19 pandemic in the major epicentres in Italy

Deaths from COVID-19 can be miscounted due to under-reporting and inaccurate death registration. Mortality is often reported at the national level, which can result in the underestimation of the true scale of the impact of the pandemic since outbreaks tend to be localised. This study exploits all-cause daily death registration data provided by the Italian Statistical Office (ISTAT) from 1 January to 31 October to estimate the excess mortality and the corresponding changes in life expectancy during the first wave of the COVID-19 pandemic. Focusing on the five most severely hit provinces in Italy (Bergamo, Brescia, Cremona, Lodi and Piacenza), we calculate the excess mortality in 2020 compared to the average mortality of the years 2015 to 2019. Moreover, we estimate the excess mortality in the first quadrimester of 2020, and the annual life expectancy at birth. The estimated excess deaths show that during this period, mortality was significantly higher than the official mortality statistics for COVID-19. According to our estimates for the first quadrimester, life expectancy in the five provinces declined by 5.4 to 8.1 for men and by 4.1 to 5.8 years for women. In addition, we find that annual life expectancy decreased by 2.4 to 4.1 years for men and by 1.9 to 2.8 years for women compared to the 2015–2019 average. Thus, we conclude that the first wave of the COVID-19 pandemic had a substantial impact on population health in the hardest hit areas in Italy

Years of good life is a well-being indicator designed to serve research on sustainability

Sustainable development (SD) as popularized by the Brundtland Commission and politically enshrined in the Sustainable Development Goals has been the explicit focus of sustainability science. While there is broad agreement that the trend of human well-being (W) over time should serve as a sustainability criterion, the literature so far has mostly addressed this in terms of its determinants rather than focusing on W itself. There is broad agreement that an indicator for W should have multiple constituents, clearly going beyond gross domestic product. Here, we propose a tailor-made indicator to serve precisely this purpose following a set of specified desiderata, including its applicability to flexibly defined subnational populations by gender, place of residence, ethnicity, and other relevant characteristics. The indicator, years of good life (YoGL), reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on life expectancy. However, since mere survival is not considered good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. We illustrate the calculation of this indicator for countries and subpopulations at different stages of development and with different degrees of data availability

A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies—ATS Brianza and ATS Bergamo—from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017–2019 and quantified differences using rate ratios (RRs). Overall, in 2017–2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017–2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients’ health in the medium and long run

Post universal health coverage trend and geographical inequalities of mortality in Thailand

BACKGROUND: Thailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage. METHODS: National vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into “super-districts” by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts. RESULTS: The overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0–14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period. CONCLUSIONS: A decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration