Income Growth, Price Variation and Health Care Demand: A Mixed Logit Model Applied to Tow-period Comparison in Rural China

1989-2006 is a period of the start and the end of deregulation of Chinese health care sector and of disintegration of rural cooperative insurance system. During this period, the government health policy has turned healthcare providers all alike into profit seeking entities. Face to perverse effects, by 2003, Chinese government begun to restore rural cooperative insurance system. From CHNS data source, we constitute two samples: 89-93 and 04-06 with respectively 2117 and 2594 rural patients surveyed roughly in the same villages in 9 Chinese provinces to compare their health choice behaviors with the evolution of price, income, distance, insurance, age, and regional inequality. Using Mixed Multinomial Logit (MMNL) estimations, we have obtained three main results. First, even in both periods there is clear price effect, in 04-06 it tends to be weaker, and heterogeneity in price preference has increased. This corresponds well the fact that between the two periods price level has significantly increased and price variation reduced. Second, there is a stronger negative distance effect and heterogeneity in 2004-06, while in 89-93 this negative impact was lower and absent for providers farther than 10km. One interpretation is the existence of a substitution effect: when patients have less possibility to discriminate providers by price, they increase their preference in choice by distance. Third, while, wealth effect exists in some choices in 89-93, it becomes absent in 04-06. Explanations may be that one the one hand both supply side and demand side conditions on health care have been improved even, to less extent though, for the poor, and on the other hand, health care is necessary goods and is price inelastic. But meanwhile, we observed catastrophic effect for the poor: the poorer patients have their share of consumption in income more decreased after health care.Empirical approach, health care demand, mixed logit model, insurance, China

Does external openness influence the infant mortality rates? An econometric investigation for the Chinese provinces.

During the last decades, China has achieved some remarkable results in improving the health status of its population. Since the end of the seventies, it has engaged in a process of large reforms in integrating with the global economy. This openness in policy has already paid important dividends in growth. The purpose of this study is to investigate if external openness had any influence on the evolution of infant mortality rates (IMR) in Chinese provinces since the beginning of the eighteen's. The first section is devoted to a brief comment on the evolution of the IMR. In section 2 and 3 we present the theoretical framework and the methodology adopted. Our hypotheses are tested with a panel data model. The results are discussed in section 4. They show that external openness had indirect effects on IMR in a way, which confirms the necessity to rebuild and expand medical insurance schemes. They also suggest it might be advisable to adopt measures in order to correct the health effects of the widening income disparities among provinces.China, panel data, external openness, infant mortality rates

Income Growth, Price Variation and Health Care Demand: A Mixed Logit Model Applied to Tow-period Comparison in Rural China

1989-2006 is a period of the start and the end of deregulation of Chinese health care sector and of disintegration of rural cooperative insurance system. During this period, the government health policy has turned healthcare providers all alike into profit seeking entities. Face to perverse effects, by 2003, Chinese government begun to restore rural cooperative insurance system. From CHNS data source, we constitute two samples: 89-93 and 04-06 with respectively 2117 and 2594 rural patients surveyed roughly in the same villages in 9 Chinese provinces to compare their health choice behaviors with the evolution of price, income, distance, insurance, age, and regional inequality. Using Mixed Multinomial Logit (MMNL) estimations, we have obtained three main results. First, even in both periods there is clear price effect, in 04-06 it tends to be weaker, and heterogeneity in price preference has increased. This corresponds well the fact that between the two periods price level has significantly increased and price variation reduced. Second, there is a stronger negative distance effect and heterogeneity in 2004-06, while in 89-93 this negative impact was lower and absent for providers farther than 10km. One interpretation is the existence of a substitution effect: when patients have less possibility to discriminate providers by price, they increase their preference in choice by distance. Third, while, wealth effect exists in some choices in 89-93, it becomes absent in 04-06. Explanations may be that one the one hand both supply side and demand side conditions on health care have been improved even, to less extent though, for the poor, and on the other hand, health care is necessary goods and is price inelastic. But meanwhile, we observed catastrophic effect for the poor: the poorer patients have their share of consumption in income more decreased after health care.Empirical approach;health care demand;mixed logit model;insurance;China

Systèmes de production rizicole et maladies parasitaires dans l'Afrique de l'Ouest : caractéristiques socio-économiques des ménages agricoles en zone de forêt ivoirienne

This study is the continuation of a study led in the savannah area. Its purpose is to describe the economic situation of households subject to malaria risk in Côte d'Ivoire forested region, so as to provide economic indicators which could eventually help explain the expected differences in malaria morbidity. A survey was conducted beside a sample of nearly 800 rural households concerned by three different farming systems (inland valleys without rice cultivation, inland valleys with no or partial water control suitable for one annual rice crop, and inland valleys with full or partial water control suitable for two rice crops per year). This survey allowed to collect economic data such as the different cultivated crops, incomes and malaria prevention expenditures. Monetary economy is based on coffee and cocoa; rice and cassava being the main food crops. If some economic differences between the three agroecosystems were observed, those differences are not so great as in the savannah area and only concern revenues: value of property accumulation is low and quite similar in the three agroecosystems. Only 34% of families used bed nets and it was mainly for the family's head and his wife. Other means of protection against mosquitoes were used by 37% of the families. For those, the monthly average expenditure was about 1000 Fcfa.Ivory Coast, cocoa, coffee, malaria, rice cultivation

Améliorer la santé dans les pays en développement – Qu’aimerait-on savoir ? Quatre questions pour des priorités

Ces dernières décennies ont été marquées par de notables progrès en matière de santé dans les pays en développement. Mais l’amélioration de la santé dans le monde en développement reste confrontée à de nombreux défis pour lesquels il y a d’importants déficits de connaissance concernant un certain nombre de « grandes questions », dont certaines interpellent particulièrement l’économiste de la santé. Quatre sont examinées dans cet article : (i) Que voudrait-on encore savoir concernant les relations entre santé et croissance ? (ii) Quelles sont les principales implications qui se dégagent de « l’hypothèse des origines foetales » ? (iii) Quels sont les points qu’il conviendrait d’approfondir au premier chef pour mieux cerner les relations entre institutions, incitations, efficience et modification des comportements en matière de demande de soins ? (iv) La répartition de l’aide à la santé, très importante en volume et en pourcentage des dépenses de santé, correspond-elle aux besoins et vient-elle réellement augmenter les ressources disponibles pour le financement de la santé ? L’article montre en quoi les zones d’ombre qui subsistent nuisent à l’efficacité et à l’efficience des politiques et des mesures permettant d’accélérer les progrès en matière de santé. Réduire ces déficits de connaissances, et en diffuser très largement les résultats, relève in fine d’une problématique de production de bien public mondial.Last decades were marked by significant progress as regards health in the developing countries, although large disparities between countries remain. But the improvement of health in the developing world is still confronted with many challenges for which there are important deficits of knowledge for several “great issues”, some of them challenging particularly health economists. This article is focused on four: (i) What would one like to still know regarding the relations between health and growth? (ii) Which are the main implications which emerge from “the fetal origins hypothesis”? (iii) Which are the hot topics which it would be advisable to look further for a better understanding of the relationships between institutions, incentives, efficiency and modification of household behaviors as regards healthcare demand? (iv) Does distribution of international aid to health, very important in volume and expressed as a percentage of the health expenditure, correspond to the needs, and really increases the available resources for the financing of health? The article shows in what the remaining areas of darkness harm the effectiveness and the efficiency of the policies and programs devoted to health improvement. Reducing these deficits of knowledge, and disseminating the related results of research is in fine an issue of producing a global public good

Dealing with Demand Heterogeneity on Health Care Provider Choice – The Case of Rural China

We built a database of two samples of patients surveyed within the same regions in rural China over a time interval of 18 years, and presumed varying demand heterogeneity due to income increase and people aging. We find that while the mean price and distance negative effects on patients choice were present in both time periods, their differences in heterogeneity, which were confirmed with the mixed multinomial logit (MMNL), could have crucial importance in avoiding erroneous policy making based merely on mean price and distance effects. We also find that while both the multinomial logit (MNL) and the MMNL are able to predict price and distance effects with low heterogeneity, only the MMNL appears able to detect the price effect when heterogeneity is high. These findings suggest using caution when interpreting estimation results with the MNL in cases of high heterogeneity

Malaria, Production and Income of the Producers of Coffee and Cocoa: an Analysis from Survey Data in Côte d’Ivoire. Malaria, coffee and cocoa production and income

The sectors of coffee and cocoa represented in Côte d'Ivoire, before the political crisis, approximately 15% of the GDP and 40% of exports. The zones of production of these two cultures are in the forest area which is infected with malaria. The culture of these products is less constraining than that of the food crops such as rice or yam (one does not need to replant each year for example). However, the maintenance of the ground and of the trees and pest management contribute to obtain high yields. In addition, these products allow the producers to obtain monetary income. However, output is not the sole determinant of the level of income: precocity and speed of gathering, by permitting early sale, contribute to get higher income. In addition, food crops such as rice growing, are produced in the area. The objective of this paper is twofold, first, to evaluate the role of malaria on coffee and cocoa productions, second, to assess if the behaviour of rural households facing a liberalisation of the coffee and cocoa chains has an impact on their income. Three functions are thus estimated: production of coffee, production of cocoa and income. Data are taken from a survey carried out on 800 households (21 villages) in 1999 in the forest area of Danané. The main results are the absence of malaria impact on productions and the dominance of individual over collective sale strategies.cocoa, coffee, lowland rice, malaria, sharecropping, Côte d’Ivoire

Income Growth, Price Variation and Health Care Demand: A Mixed Logit Model Applied to Tow-period Comparison in Rural China

1989-2006 is a period of the start and the end of deregulation of Chinese health care sector and of disintegration of rural cooperative insurance system. During this period, the government health policy has turned healthcare providers all alike into profit seeking entities. Face to perverse effects, by 2003, Chinese government begun to restore rural cooperative insurance system. From CHNS data source, we constitute two samples: 89-93 and 04-06 with respectively 2117 and 2594 rural patients surveyed roughly in the same villages in 9 Chinese provinces to compare their health choice behaviors with the evolution of price, income, distance, insurance, age, and regional inequality. Using Mixed Multinomial Logit (MMNL) estimations, we have obtained three main results. First, even in both periods there is clear price effect, in 04-06 it tends to be weaker, and heterogeneity in price preference has increased. This corresponds well the fact that between the two periods price level has significantly increased and price variation reduced. Second, there is a stronger negative distance effect and heterogeneity in 2004-06, while in 89-93 this negative impact was lower and absent for providers farther than 10km. One interpretation is the existence of a substitution effect: when patients have less possibility to discriminate providers by price, they increase their preference in choice by distance. Third, while, wealth effect exists in some choices in 89-93, it becomes absent in 04-06. Explanations may be that one the one hand both supply side and demand side conditions on health care have been improved even, to less extent though, for the poor, and on the other hand, health care is necessary goods and is price inelastic. But meanwhile, we observed catastrophic effect for the poor: the poorer patients have their share of consumption in income more decreased after health care

Two-Period Comparison of Healthcare Demand with Income Growth and Population Aging in Rural China: Implications for Adjustment of the Healthcare Supply and Development

We estimate the evolution of healthcare demand under the influence of income growth and population aging with two samples of patients surveyed in the same regions, but with an interval of 18 years in rural China and with mixed logit to deal with heterogeneity. In accordance with theoretical and inductive inferences, it is found that healthcare price effects decreased and became more heterogeneous. Aging impact overweighed income growth impact, resulting in increasing distance effect and patients' preference to proximity. In the face of this demand change, the adjustment of governmental supply should be to promote small and middle-sized healthcare providers. However during this period to cope with urbanization, the Chinese policy consisted of privileging large hospitals. This has led to a higher share of patients, especially the aging patients, to choose self-care and a higher share of poorer patients to suffer from catastrophic health expenditures. This finding carries broad implications for rural health policy-making on, along with income growth, population aging and urbanization, how to provide better coverage of rural areas by enough qualified and multifunctional small and middle-sized healthcare providers in the developing world

Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data

In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China, New Rural Cooperative Medical Scheme, Technical efficiency, data envelopment analysis, Township Hospitals.