Essays on evaluating a community based health insurance scheme in rural Ethiopia

__Abstract__ Since the late 1990s, in a move away from user fees for health care and with the aim of creating universal access, several low and middle income countries have set up community-based health insurance (CBHI) schemes. Following this approach, in June 2011, with the aim of enhancing access to health care and reducing the burden of out-of-pocket health care expenditure, the Government of Ethiopia rolled out a pilot CBHI scheme. The scheme caters to rural households and urban informal sector workers in 13 districts located in four main regions (Tigray, Amhara, Oromiya, and SNNP) of the country. The main aims of this thesis are to assess the factors that drive initial scheme uptake and contract renewal and to identify the impact of CBHI on utilization of care and financial protection. As a prelude to an assessment of these issues, the thesis also provides a systematic review of the literature on CBHI schemes and uses five clinical vignettes to assess the demand for modern health care in rural Ethiopia. The thesis uses data obtained from various sources: three waves of a household panel survey, a health facility survey and qualitative information gathered through focus group discussions and key informant interviews

Firm Heterogeneity and Development: A Meta Analysis of FDI Productivity Spill-overs

abstract: In order to assess the relationship between economic development and firm heterogeneity, this paper studies productivity levels in the context of FDI. We illustrate that developing and emerging countries show a lot of variation in the extent of heterogeneity of their populations of firms. Heterogeneity is a bit stronger at per capita GDP levels below $10.000, but also remains substantial at higher levels of development We take stock of the rich literature on FDI-spill-overs analysing econometric studies on FDI spill-over effects that were published over the period 1983-2008 and deal with national studies in 30 developing countries and emerging markets. One important finding is that these studies tend to ignore two sources of heterogeneity: exports and – especially – R&D. We use a meta-analysis to correct for differences in research design (including regional effects, sample size and level of aggregation) and investigate the spill-over effects of foreign firms on domestic firms. Focusing on the effect of firm heterogeneity on productivity, we investigate several sources of heterogeneity including firm size (production share), internationalization (both exports and foreign ownership) and labour quality. We observe positive, and significant effects for heterogeneity in terms of labour quality, size and export as 44% –66% of the coefficients are significant and positive and less than 9% of the coefficients are negative and significant. This robustness contrasts with contradictory findings for foreign ownership where 63% of the coefficients are insignificant or negative. At another level this study identifies research design factors that influence the reported findings on FDI spill-over analysis