Health insurance impacts on health and nonmedical consumption in a developing country

The authors examine the effects of the introduction of Vietnam's health insurance (VHI) program on health outcomes, health care utilization, and non-medical household consumption. The use of panel data collected before and after the insurance program's introduction allows them to eliminate any confounding effects due to selection on time-invariant un-observables, and their coupling of propensity score matching with a double-difference estimator allows them to reduce the risk of biases due to inappropriate specification of the outcome regression model. The authors'results suggest that Vietnam's health insurance program impacted favorably on height-for-age and weight-for-age of young school children, and on body mass index among adults. Their results suggest that among young children, VHI increases use of primary care facilities and leads to a substitution away from the use of pharmacists as a source of advice and non-prescribed medicines toward the use of them as a supplier of medicines prescribed by a health professional. Among older children and adults, VHI results in a marked increase in the use of hospital inpatient and outpatient departments. The results also suggest that VHI causes a reduction in annual out-of-pocket expenditures on health and an increase in non-medical household consumption, including food consumption, but mostly nonfood consumption. The authors'estimate of the VHI-induced reduction in out-of-pocket health spending is considerably smaller than their estimate of the VHI-induced increase in non-medical consumption, which is consistent with the idea that households hold back their consumption considerably if, through lack of health insurance, they are exposed to the risk of large out-of-pocket expenditures. This is especially plausible in a country where at the time (1993), a single visit to a public hospital cost on average the equivalent of 20 percent of a person's annual nonfood consumption.Health Monitoring&Evaluation,Health Economics&Finance,Environmental Economics&Policies,Insurance&Risk Mitigation,Health Systems Development&Reform

Measuring poverty using qualitative perceptions of welfare

The authors show how subjective poverty lines can be derived using simple qualitative assessments of perceived consumption adequacy, based on a household survey. Respondents were asked whether their consumption of food, housing, and clothing was adequate for their family's needs. The author's approach, by identifying the subjective poverty line without the usual"minimum-income question,"offers wide applications in developing country settings. They implement it using survey data for Jamaica and Nepal. The implied subjective poverty lines are robust to alternative methods of dealing with other components of consumption, for which the subjective"adequacy"question was not asked. The aggregate poverty rates based on subjective poverty lines come close to those based on independent"objective"poverty lines. There are notable differences, however, when geographic and demographic poverty profiles are constructed.Health Monitoring&Evaluation,Environmental Economics&Policies,Public Health Promotion,Services&Transfers to Poor,Poverty Reduction Strategies,Poverty Assessment,Poverty Lines,Environmental Economics&Policies,Inequality,Achieving Shared Growth

Demand for public safety

In public safety of less concern to poor people? What about people in poor areas? How is demand for public safety affected by income inequality? Is there a self-correcting mechanism whereby higher crime increases demand for public safety? The authors study subjective assessments of public safety using a comprehensive socioeconomic survey of living standards in Brazil. They find public safety to be a normal good at the household level. Marginal income effects are higher for the poor, so inequality reduces aggregate demand for public safety. Less public safety generates higher demand for improving it. Living in a poor area increases demand at given own-income. So does living in an area with higher average education.Engineering,Economic Theory&Research,Public Health Promotion,Housing&Human Habitats,Health Monitoring&Evaluation,Housing&Human Habitats,Engineering,Economic Theory&Research,Health Monitoring&Evaluation,Environmental Economics&Policies

Local conflict in Indonesia : Measuring incidence and identifying patterns

The widespread presence of local conflict characterizes many developing countries such as Indonesia. Outbreaks of violent conflict not only have direct costs for lives, livelihoods, and material property, but may also have the potential to escalate further. Recent studies on large-scale"headline"conflicts have tended to exclude the systematic consideration of local conflict, in large part due to the absence of representative data at low levels of geographic specification. This paper is a first attempt to correct for that. We evaluate a unique dataset compiled by the Indonesian government, the periodic Village Potential Statistics (PODES), which seeks to map conflict across all of Indonesia's 69,000 villages/neighborhoods. The data confirm that conflict is prevalent beyond well publicized"conflict regions,"and that it can be observed across the archipelago. The data report largely violent conflict in 7.1 percent of Indonesia's lowest administrative tier (rural desa and urban kelurahan). Integrating examples from qualitative fieldwork, we assess issues in the measurement of local conflict for quantitative analysis, and adopt an empirical framework to examine potential associations with poverty, inequality, shocks, ethnic and religious diversity/inequality, and community-level associational and security arrangements. The quantitative analysis shows positive correlations between local conflict and unemployment, inequality, natural disasters, changes in sources of incomes, and clustering of ethnic groups within villages. The institutional variables indicate that the presence of places of worship is associated with less conflict, while the presence of religious groups and traditional culture (adat) institutions are associated with conflict. We conclude by suggesting future areas of research, notably on the role of group inequality and inference, and suggest ways to improve the measurement of conflict in the village census.Services&Transfers to Poor,Post Conflict Reconstruction,Public Health Promotion,Education and Society,Peace&Peacekeeping,Post Conflict Reconstruction,Education and Society,Social Conflict and Violence,Rural Poverty Reduction,Services&Transfers to Poor

Health Spending and Decentralization in Indonesia

Using a panel dataset of 320 Indonesian districts we examine the impact of district budgets on public health spending, utilization patters in the public and private sector, and private health spending in the four years after decentralization. We exploit the panel structure of the data and the fact that district budgets are largely driven by central government transfers to determine causal patterns. We find that the elasticity of public health spending with respect to district budgets is around 0.9 with a higher elasticity for development spending than for routine spending. District splits reduce public health spending. We find a positive effect of public district health spending on public sector utilization, with the strongest effects in the poorest two quintiles. We find no significant effects on private sector utilization and out of pocket health expenditures. --public spending,health,decentralization

Measurements of poverty in Indonesia - 1996, 1999, and beyond

Indonesia's economic crisis has caused a consumption expenditures deterioration in the welfare of Indonesians. Focusing on only one dimension of individual, and family welfare - consumption expenditures - the authors analyze two issues associated with the measurement of poverty. The first issue is how to produce regionally consistent poverty lines - that is, how to define a level of spending for each region that produces the same material standard of living. Without comparable data on prices, there is a problem of circularity. Choosing the reference population is important for defining the price level by which to deflate money expenditures to reach the same welfare level, but one needs to know the price level to define the reference population as a group with the same real expenditures. To address the problem of circularity, the authors use an iterative approach to defining poverty, one that produces consistent results across regions. They then use those poverty lines to examine the common"poverty profiles"(by location, sector, and so on). The second issueis more conceptual: how to expand the narrow measure of poverty, based on spending for consumption, with extensions that expand how welfare is measured, and allow more consistent comparisons of different individuals'welfare levels.Environmental Economics&Policies,Health Systems Development&Reform,Poverty Reduction Strategies,Health Economics&Finance,Public Health Promotion,Poverty Reduction Strategies,Poverty Lines,Poverty Assessment,Environmental Economics&Policies,Achieving Shared Growth

Poverty, education, and health in Indonesia : who benefits from public spending?

The authors investigate the extent to which Indonesia's poor benefit from public and private provisioning of education and health services. Drawing on multiple rounds of SUSENAS household surveys, they document a reversal in the rate of decline in poverty and a slowdown in social sector improvements resulting from the economic crisis in the second half of the 1990s. Carrying out traditional static benefit-incidence analysis of public spending in education and health, the authors find patterns consistent with experience in other countries: spending on primary education and primary health care tends to be pro-poor, while spending on higher education and hospitals is less obviously beneficial to the poor. These conclusions are tempered once one allows for economies of scale in consumption which weaken the link between poverty status and household size. The authors also examine the incidence of changes in government spending. They find that the marginal incidence of spending in both junior and senior secondary schooling is more progressive than what static analysis would suggest, consistent with"early capture"by the non-poor of education spending. In the health sector marginal and average incidence analysis point to the same conclusion: the greatest benefit to the poor would come from an increase in primary health care spending.Public Health Promotion,Health Monitoring&Evaluation,Health Economics&Finance,Health Systems Development&Reform,Early Child and Children's Health,Health Systems Development&Reform,Health Monitoring&Evaluation,Poverty Assessment,Health Economics&Finance,Achieving Shared Growth

Did the Healthcard Program ensure Access to Medical Care for the Poor during Indonesia's Economic Crisis?

The Indonesian Healthcard program was implemented in response to the economiccrisis, which hit Indonesia in 1998, in order to preserve access to health care servicesfor the poor. The Healthcard provided the households with subsidised care at publichealth care providers, while the providers themselves received budgetary support tocompensate for the extra demand. This papers looks at the impact of this program onoutpatient care utilisation, and, in particular, endeavours to disentangle the directeffect of the allocation of Healthcards from the indirect effect of the transfer of fundsto health care facilities. It finds that the program resulted in a net increase inutilisation for the poor beneficiaries. Por non-poor beneficiaries the program resultedin a substitution from private to public providers only. However, the largest effect ofthe program seems to have come from a general increase in the quality of publicservices resulting from the budgetary support they received through this program