The Price Sensitivity of Health Plan Choice: Evidence from Retirees in the German Social Health Insurance

We investigate two determinants of the price sensitivity of health plan demand: the size of the choice set and the salience of premium differences. Using variation in both features in the German Social Health Insurance (SHI) and information on health plan switches of retirees in the German Socio Economic Panel, augmented with information on individuals’ choice sets we find that retirees react less to potential savings from switching when they have more plans to choose from and when differences between premiums are less salient. Simplifying choices could save consumers money and improve the functioning of the health insurance market

Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act

Background: The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10%-15% of the US population remains uninsured. Objectives: To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant. Research Design: Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013. Subjects: A total of 2742 US residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel. Measures: Self-reported health insurance status and type as of spring 2015. Results: Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared with low financial literacy, and 9.2 percentage points higher with high compared with low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance through Medicaid or the Marketplaces compared with being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates. Conclusions: A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics

Achieving high-quality universal health coverage: a perspective from the National Health Service in England

Governments across low-income and middle-income countries have pledged to achieve universal health coverage by 2030, which comes at a time where healthcare systems are subjected to multiple and persistent pressures, such as poor access to care services and insufficient medical supplies. While the political willingness to provide universal health coverage is a step into the right direction, the benefits of it will depend on the quality of healthcare services provided. In this analysis paper, we ask whether there are any lessons that could be learnt from the English National Health Service, a healthcare system that has been providing comprehensive and high-quality universal health coverage for over 70 years. The key areas identified relate to the development of a coherent strategy to improve quality, to boost public health as a measure to reduce disease burden, to adopt evidence-based priority setting methods that ensure efficient spending of financial resources, to introduce an independent way of inspecting and regulating providers, and to allow for task-shifting, specifically in regions where staff retention is low

Islamic inheritance law, son preference and fertility behavior of Muslim couples

Abstract I examine whether the son preference and fertility behavior of Muslim couples respond to the risk of inheritance expropriation by their extended family. According to traditional Islamic inheritance principles only the son of a deceased man can exclude his male agnates from inheritance and preserve his estate within the nuclear household. I exploit cross-sectional and time variation in the application of the Islamic inheritance exclusion rule in Indonesia: between Muslim and non-Muslim populations affected by different legal systems, across men with different sibling sex composition, and before and after a change in Islamic law that allowed female children to exclude male relatives. I find that Muslim couples more affected by the exclusion rule exhibit stronger son preference, practice sex-differential fertility stopping, attain a higher proportion of sons and have larger families than non-Muslims or Muslims for whom the exclusion rule is less binding. JEL codes: J12 J13 J16 K

Mind the costs, too : towards better cost-effectiveness analyses of PBF programmes

- The evidence surrounding the cost-effectiveness of performance-based financing (PBF) is weak, and it is not clear how PBF compares with alternative interventions in terms of its value for money. - It is important to fill this evidence gap as countries transition from aid and face increasing budget constraints and competing priorities for the use of their domestic resources. - In conducting cost-effectiveness analyses of PBF, researchers should be mindful of the identification, measurement and valuation of costs and effects, provide justification for the scope of their studies, and specify appropriate comparators and decision rules. - We also recommend the use of a reference case to lay out the principles, preferred methodological choices and reporting standards, as well as a checklist

Impact of the influx of Syrian refugees on domestic violence against Jordanian women: Evidence from the 2017-18 Jordan Population and Family Health Survey.

The 2011 Syrian crisis led to a large influx of refugees into neighboring countries, including Jordan. The resulting stress on local host communities could heighten the risk of domestic violence against Jordanian women. We utilized multilevel propensity score weighting and data from the 2017-18 Jordan Population and Family Health Survey to empirically test for differences in outcomes related to domestic violence, marital control, and justification of wife-beating between Jordanian communities with varying density levels of Syrian women. We did not find systematic differences in these outcomes across communities. However, we cannot rule out effects that may not be statistically detectable with our sample but could still be substantively meaningful

Does Deforestation Increase Malaria Prevalence? Evidence from Satellite Data and Health Surveys

Deforestation has been found to increase malaria risk in some settings, while a growing number of studies have found that deforestation increases malaria prevalence in humans, suggesting that in some cases forest conservation might belong in a portfolio of anti-malarial interventions. However, previous studies of deforestation and malaria prevalence were based on a small number of countries and observations, commonly using cross-sectional analyses of less-than-ideal forest data at the aggregate jurisdictional level. In this paper we combine fourteen years of high-resolution satellite data on forest loss with individual-level data from Demographic and Health Surveys on malaria in more than 60,000 rural children in 17 countries in Africa, and fever in more than 470,000 rural children in 41 countries in Latin America, Africa, and Asia. Adhering to methods that we pre-specified in a pre-analysis plan, we tested ex-ante hypothesis based on previous literature. Using a cross-sectional regression we reject the ex-ante hypotheses that deforestation increases malaria prevalence and that intermediate levels of forest cover have highest malaria prevalence. We further reject ex ante hypotheses related to disaggregations: that the effect of deforestation on malaria is greater in Latin America and Africa than Asia, greater at earlier stages of a forest transition, greater for smaller cuts, and diminishes in effect over time. In panel regressions performed on a sub-sample of data from locations where repeated measurements were available, we also found no support for our ex ante hypotheses. And less than one-quarter of cross-sectional regressions performed on data from individual countries and years showed results consistent with our ex ante hypothesis. Because we did not find a significant effect we did not carry out initial plans to test for mediating factors, nor did we undertake a planned cost-effectiveness analysis. Our findings differ from the majority of previous empirical studies, which found that deforestation increases malaria prevalence in other contexts. We speculate that this difference may be due to an "African exception to drivers of deforestation" (Fisher, 2010) in which deforestation in Africa is largely driven by the slow expansion of subsistence or smallholder agriculture for domestic use by long-time residents in stable socio-economic settings rather than rapid clearing for market-driven agricultural exports by new frontier migrants as in Latin America and Asia. Our results imply that at least in Africa forest conservation does not appear to be an effective anti-malarial intervention. Anti-malarial efforts in Africa should focus on other proven interventions such as bed nets, indoor spraying, and housing improvements. Forest conservation efforts should focus on securing other benefits of forests, including carbon storage, biodiversity habitat, clean water provision, and other goods and services.peerReviewe

The Quality of Primary Care in Cambodia: An Assessment of Knowledge and Effort of Public Sector Maternal and Child Care Providers

Health Systems & Reform81Jan-2

Asylum-seekers in Germany differ from regularly insured in their morbidity, utilizations and costs of care

<div><p>In the wake of the European refugee crisis, Germany has received over a million new applications for asylum in the last two years. The health care system is struggling to provide asylum-seekers with access to essential medical services and facilitate their longer-term integration. In this article, we report on the morbidity, utilization and costs of care for a sample of asylum-seekers as compared to a matched group of regularly insured. Using administrative data, we found that asylum-seekers had more hospital and emergency department admissions, including more admissions that could be avoided through good outpatient care or prevention. Their average expenditures were 10 percent higher than for the regularly insured, mostly because of higher hospital expenditures, although there was substantial variation in expenditures by country of origin. Facilitating access to the health care system, especially outpatient and mental health care, could improve asylum-seekers health status and integration, possibly at lower costs.</p></div

Using supervised learning to select audit targets in performance-based financing in health: An example from Zambia.

Independent verification is a critical component of performance-based financing (PBF) in health care, in which facilities are offered incentives to increase the volume of specific services but the same incentives may lead them to over-report. We examine alternative strategies for targeted sampling of health clinics for independent verification. Specifically, we empirically compare several methods of random sampling and predictive modeling on data from a Zambian PBF pilot that contains reported and verified performance for quantity indicators of 140 clinics. Our results indicate that machine learning methods, particularly Random Forest, outperform other approaches and can increase the cost-effectiveness of verification activities