Essays on Risk-Sharing and Development.

Individuals living in developing economies are subject to a wide variety of risks. Moreover, since private and public formal institutions designed to help individuals coping with risks tend to be weaker and narrower than in rich countries, these risks very often bear a heavy burden on welfare. If the preferences of agents can be characterized by concave utility functions, these agents will want to spread risk across time and among themselves. We focus here on mechanisms allowing agents to share risk among themselves, and we look more particularly at environments where formal insurance options are incomplete or absent. This thesis offers three chapters which goal is to analyze the extent to which risk sharing is affected by imperfections in the insurance or in the credit markets. In the first two chapters, we take a microeconomic perspective and we examine how rural farmers cope with income shocks in village economies characterized by the absence of formal insurance markets. In the last chapter, we adopt a macroeconomic perspective and we look at the role of the domestic financial sector development in fostering risk sharing through financial integration between countries.Development economics -- Pacific Area; Risk assessment -- Vietnam; Depressions -- Developing countries; Social security -- Developing countries; Vietnam -- Economic conditions -- 21st century;

Understanding Health Workers' Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment

Background Timor-Leste built its health workforce up from extremely low levels after its war of independence, with the assistance of Cuban training, but faces challenges as the first cohorts of doctors will shortly be freed from their contracts with government. Retaining doctors, nurses and midwives in remote areas requires a good understanding of health worker preferences. Methods The article reports on a discrete choice experiment (DCE) carried out amongst 441 health workers, including 173 doctors, 150 nurses and 118 midwives. Qualitative methods were conducted during the design phase. The attributes which emerged were wages, skills upgrading/specialisation, location, working conditions, transportation and housing. Findings One of the main findings of the study is the relative lack of importance of wages for doctors, which could be linked to high intrinsic motivation, perceptions of having an already highly paid job (relative to local conditions), and/or being in a relatively early stage of their career for most respondents. Professional development provides the highest satisfaction with jobs, followed by the working conditions. Doctors with less experience, males and the unmarried are more flexible about location. For nurses and midwives, skill upgrading emerged as the most cost effective method. Conclusions The study is the first of its kind conducted in Timor-Leste. It provides policy-relevant information to balance financial and non-financial incentives for different cadres and profiles of staff. It also augments a thin literature on the preferences of working doctors (as opposed to medical students) in low and middle income countries and provides insights into the ability to instil motivation to work in rural areas, which may be influenced by rural recruitment and Cuban-style training, with its emphasis on community service.Our Research Report for 2000-2002 reflects an outstanding level of achievement throughout the institution and demonstrates once again our high level of commitment to strategic and applied research particularly in areas that enhance the quality of life.Funding: The authors thank the Australian Department of Foreign Affairs and Trade and the European Commission for their financial support.sch_iih11pub4608pub1

Essays on risk-sharing and development

Defense date: 17 June 2010Examining Board: Prof. Morten Ravn, University College London, Supervisor Prof. Stefan Dercon, University of Oxford Prof. Massimiliano Marcellino, EUI Prof. Guglielmo Weber, University of PadovaIndividuals living in developing economies are subject to a wide variety of risks. Moreover, since private and public formal institutions designed to help individuals coping with risks tend to be weaker and narrower than in rich countries, these risks very often bear a heavy burden on welfare. If the preferences of agents can be characterized by concave utility functions, these agents will want to spread risk across time and among themselves. We focus here on mechanisms allowing agents to share risk among themselves, and we look more particularly at environments where formal insurance options are incomplete or absent. This thesis offers three chapters which goal is to analyze the extent to which risk sharing is affected by imperfections in the insurance or in the credit markets. In the first two chapters, we take a microeconomic perspective and we examine how rural farmers cope with income shocks in village economies characterized by the absence of formal insurance markets. In the last chapter, we adopt a macroeconomic perspective and we look at the role of the domestic financial sector development in fostering risk sharing through financial integration between countries

The Structure of Default Rule in Contract Law : Toward a Conception of Welfare-Based Default Rule

textabstractThe last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. We propose a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. We break service coverage into prevention and treatment, and financial protection into impoverishment and catastrophic spending; we use nationally representative household survey data to adjust population averages to capture inequalities between the poor and better off; we allow non-linear trade-offs between and within the two dimensions of the UHC index; and we express all indicators such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which we have detailed information on UHC-inspired reforms, we find a cluster of high-performing countries with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico, and South Africa) and a cluster of low-performing countries with UHC scores in the range 35–57 (Ethiopia, Guatemala, India, Indonesia, and Vietnam). We find that countries have mostly improved their UHC scores between the earliest and latest years for which we have data—by about 5 points on average. However, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare

Progress on catastrophic health spending in 133 countries: a retrospective observational study

__Background__ The goal of universal health coverage (UHC) requires inter alia that families who get needed health care do not suffer undue financial hardship as a result. This can be measured by the percentage of people in households whose out-of-pocket health expenditures are large relative to their income or consumption. We aimed to estimate the global incidence of catastrophic health spending, trends between 2000 and 2010, and associations between catastrophic health spending and macroeconomic and health system variables at the country level. __Methods__ We did a retrospective observational study of health spending using data obtained from household surveys. Of 1566 potentially suitable household surveys, 553 passed quality checks, covering 133 countries between 1984 and 2015. We defined health spending as catastrophic when it exceeded 10% or 25% of household consumption. We estimated global incidence by aggregating up from every country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We used multiple regression to explore the relation between a country’s incidence of catastrophic spending and gross domestic product (GDP) per person, the Gini coefficient for income inequality, and the share of total health expenditure spent by social security funds, other government agencies, private insurance schemes, and non-profit institutions. __Findings__ The global incidence of catastrophic spending at the 10% threshold was estimated as 9·7% in 2000, 11·4% in 2005, and 11·7% in 2010. Globally, 808 million people in 2010 incurred catastrophic health spending. Across 94 countries with two or more survey datapoints, the population-weighted median annual rate of change of catastrophic payment incidence was positive whatever catastrophic payment incidence measure was used. Incidence of catastrophic payments was correlated positively with GDP per person and the share of GDP spent on health, and incidence correlated negatively with the share of total health spending channelled through social security funds and other government agencies. __Interpretation__ The proportion of the population that is supposed to be covered by health insurance schemes or by national or subnational health services is a poor indicator of financial protection. Increasing the share of GDP spent on health is not sufficient to reduce catastrophic payment incidence; rather, what is required is increasing the share of total health expenditure that is prepaid, particularly through taxes and mandatory contributions

Assessing Latin America’s Progress Toward Achieving Universal Health Coverage

Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens’ rights to health care and counting the number of people who are in a financial protection scheme that safeguards them from high health care payments. On these metrics most countries in Latin America have already “reached” universal health coverage. Neither metric indicates, however, whether a country has achieved universal health coverage in the now commonly accepted sense of the term: that everyone—irrespective of their ability to pay—gets the health services they need without suffering undue financial hardship. We operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and then constructed an overall index of universal health coverage achievement. We applied the approach using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries. No country has achieved a perfect universal health coverage score, but some countries (including those with more integrated health systems) fare better than others. All countries except one improved in overall universal health coverage over the time period analyzed