Health Economics

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    ASSURANCE MALADIE ET UTILISATION DES SERVICES DE SANTE AU BENIN
    (DE L’UNIVERSITE D’ABOMEY-CALAVI (BENIN), 2017-04-21) ZOUNMENOU, Alexandre Yédjannavo
    L’utilisation des services de santé constitue un des facteurs indispensables à l’amélioration de l’état de santé des populations. Ainsi, de nombreux efforts ont été consacrés par les autorités nationales et les partenaires extérieurs au cours des dernières décennies pour améliorer l’offre des services de santé dans les pays en développement. Mais, force est de constater que l’utilisation des services de santé reste toujours faible en Afrique. Au Bénin, le taux de couverture en infrastructure sanitaire est de 93,1% en 2015. Ce fort taux témoigne d’une meilleure couverture en infrastructure sanitaire. Cependant, le taux de fréquentation des services de santé est relativement faible et s’établit à 50,3%. Compte tenu de l’écart entre ces deux taux, les travaux sur l’utilisation des services de santé soutiennent en majorité que recentrer le débat de l’accès aux soins de santé du côté de la demande va permettre d’améliorer l’utilisation des services de santé pour les couches défavorisées de la population. La présente dissertation doctorale mobilise les théories de la demande pour analyser l’utilisation des services de santé au Bénin. Elle s’organise autour de trois chapitres et défend la thèse selon laquelle la faible utilisation des services de santé au Bénin est due à la faible couverture en assurance maladie. Les modèles de choix discrets développés tout au long du travail, logit dans les deux premiers chapitres et logit multinomial dans le troisième chapitre, fournissent des arguments empiriques pour valider les développements théoriques. Les analyses du premier chapitre nous ont permis de conclure que l’assurance maladie publique favorise l’utilisation des services de santé. L’amélioration de l’utilisation des services de santé au Bénin passe donc par l’augmentation de la couverture en assurance maladie publique. L’influence des groupes d’assurance informelle (nujè mèji gbê) sur l’utilisation des services de santé reste mitigée. Cependant, l’appartenance à un groupe d’assurance informelle contribue à réduire les dépenses de santé. Le logit multinomial estimé dans le troisième chapitre nous a permis de confirmer l’intuition selon laquelle l’assurance maladie formelle est réservée aux ménages riches et aux ménages dirigés par des individus ayant fait des études supérieures. Toutefois, les mutuelles de santé initiées pour étendre la protection contre le risque maladie aux travailleurs du secteur informel et plus précisément aux ménages pauvres ne leur sont pas accessibles.
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    ECONOMIC BURDEN OF MALARIA IN TANZANIA: AN INVESTIGATION OF CHILDREN UNDER FIVE YEARS
    (University of Dar es Salaam, 2017-11-22) Chamwali, Lihoya Anthony
    The importance of having good health for both parents and their children cannot be ignored, as it allows households to participate effectively in activities which earn them income. This study analyzes the economic burden of malaria in Tanzania for households with children under five years. Specifically it examines the effect of the presence of the under five malaria admissions on households’ incomes and wages, estimates the effect of the presence of under five malaria admissions on households’ agricultural output and finds out the determinants of under five malaria admissions. The study uses the Tanzania National Panel Survey (TNPS) data set which was conducted in three waves by the National Bureau of Statistics (NBS). The first, second and third waves were conducted in years 2008/9, 2010/11 and 2012/13 respectively. The survey covered more than 3000 households in each wave. But for the purpose of this study, more than 600 households who had under five children and who were interviewed in all the three rounds formed the main sample size of the study. A fixed effect model is used to analyze the effect of the presence of the under five malaria admissions on households’ wages and incomes. Ordinary Least Square (OLS) is used to analyze the effect of the presence of the under five malaria admissions on households’ agricultural output and the panel logit regression model is used to find the determinants of the under five malaria admissions. The results reveal that the presence of the under five children admitted with malaria in a household burdens households as its income and wages are reduced by 12.06 percent and 6.6 percent respectively, while households’ agricultural output was reduced by 18.94 percent in 2008/9 and by 28.94 percent in 2012/13 holding climate related factors constant. The study has also revealed that a large size of the household , age of the household head and sources of drinking water (both well water, river water and piped water) put the under five children at risk of having malaria admissions. The policy implications of the findings are that the government needs to focus on the prevention of malaria through indoor and outdoor spraying in addition to the distribution of free mosquito nets. A malaria free society will allow households to increase hours of work in productive activities and this will increase their incomes. Households will also become food secure if malaria rates are reduced due to effective participation in agricultural activities.Besides, the government needs to ensure that leaking pipes are repaired timely so as to reduce the mosquitoes breeding places, especially ponds of leaked water around homes.
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    HEALTH EXPENDITURE, HEALTH OUTCOMES AND ECONOMIC GROWTH IN SUB-SAHARAN AFRICA
    (UNIVERSITY OF BENIN, 2015-07-01) ARTHUR, Eric
    The study examines the interrelationship among health expenditure, health outcomes and economic growth in some selected Sub-Saharan African (SSA) countries. These countries have made significant efforts in increasing health expenditure over the years, with the aim of improving health outcomes and accelerating economic growth. Despite this, health outcomes have only responded marginally in SSA, raising concerns on the significance of health expenditure in improving health outcomes. Besides, empirical evidence of the effect of health outcomes on economic growth is mixed. This study thus investigates the effect of health expenditure on health outcomes, applying the fixed effects model. Further, the study examines the effect of health outcomes on economic growth using the Generalised Method of Moments (GMM) estimator. Lastly, the study tests the causal relationship among health expenditure, health outcomes, and economic growth using Panel Vector Autoregressive (PVAR) model. The data for the study were sourced from the 2012 World Bank’s World Development Indicators (WDI) for a sample of 40 SSA countries from 1995 to 2011. The findings from the study indicate that health expenditure has a significant, but inelastic effect on health outcomes in SSA, reducing mortality rates and improving life expectancy at birth. Reductions in mortality rates were significantly influenced by public health expenditure, whereas improvements in life expectancy at birth were significantly influenced by private health expenditure. There is, however, a strong complementary relationship between private and public health expenditures in SSA, despite the dominance of the former over the latter. In addition, clean water, proper sanitation and immunisation rates were found to enhance health outcomes, whereas the prevalence of diseases and urban population growth rates had deleterious effects on health outcomes. Health outcomes were also found to contribute significantly to economic growth in SSA. The empirical evidence indicates that this was driven more by reductions in mortality rates than by improvements in life expectancy at birth in the region. Physical capital, education and openness to trade contribute positively to economic growth, whereas the age dependency ratio serves as a drag on growth rate. Lastly, the findings indicate bidirectional causality between health expenditure and health outcomes, between health outcomes and economic growth and unidirectional causality from health expenditure to economic growth. xiii Given the significant, but inelastic effect of health expenditure on health outcomes and the significant contribution of health outcomes to economic growth, the study recommends that SSA countries should make efforts to increase health expenditure to improve health outcomes in order to speed up growth. In particular, there should be deliberate efforts to increase public health expenditure with a view to reducing the burden of private health spending on individuals. This perhaps can be achieved through effective health insurance schemes, which will enable people to save against financial crisis that may arise due to ill health, thereby reducing out-of-pocket health expenditure. In addition, there is the need for public enlightenment on the importance of constant health check-ups given the significance of the use of preventive health care in enhancing health outcomes. Furthermore, it is necessary to improve environmental conditions due to the negative effects of such conditions on health outcomes. Finally, there is the need to manage the population growth rates in SSA countries to reduce the age dependency ratio in order to enhance the growth rate of per capita GDP in the region.
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    INDOOR AIR POLLUTION FROM HOUSEHOLD ENERGY USE IN KENYA: ANALYSIS OF THE HEALTH OUTCOMES AND ABATEMENT EFFORTS
    (University of Nairobi, 2015-09-08) OSIOLO, HELEN HOKA
    This thesis investigates the health outcomes of indoor air pollution from household energy use and demand for IAP abatement interventions. It has four objectives; first it determines the factors that influence the levels of indoor air pollution from household energy use, second it investigates the association between indoor air pollution form household energy use and ill health, third it estimates the health cost and productivity effects of household energy use and lastly it analyses the demand for indoor air pollution abatement interventions. The study uses data from the Kenya Integrated Household Budget Survey conducted by the Government of Kenya in 2005/06. Different approaches, including; the Conditional Mixed Process ordered probit, Multivariate regression and the Heckman sample selection models are used to correct for endogeneity, address unobserved heterogeneity and sample selection bias. The study also uses the cost of illness approach to estimate the health cost and productivity effects of household energy use. The results indicate that education, income and type of dwelling are the key factors that influence the level of indoor air pollution. In particular, households with low levels of income and those living in manyatta type of dwellings are likely to encounter high levels of indoor air pollution. The findings indicate that household members using firewood, kerosene and traditional stove appliances are likely to manifest upper respiratory infection, lower respiratory infection and eyes illness. In addition, the health cost for lower respiratory illness and eyes illness are found to be higher than for upper respiratory illness. Consequently the results show that; the geographical location, type of household energy used, cooking place/area, type of dwelling, income and whether households had a chimney or not are key factors that determines the demand for indoor air pollution abatement interventions. In order to reduce indoor air pollution and improve health outcomes, it is important the government introduces policies that target reduction of indoor air pollution from household energy use. Though such policies may include enhancing the use of modern energy, improved stoves and chimney as indoor air pollution abatement interventions; there is need to focus on income, education, age, and residential location.
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    TECHNICAL EFFICIENCY AND TOTAL FACTOR PRODUCTIVITY GROWTH IN UGANDA’S DISTRICT REFERRAL HOSPITALS
    (UNIVERSITY OF DAR ES SALAAM, 2006-09-01) Yawe, Bruno Lule
    The study measures the technical efficiency and total factor productivity growth of 25 district referral hospitals from three regions of Uganda over the 1999-2003 period. This study is motivated by a desire to evaluate the ongoing health sector reforms in Uganda which in part are seeking to improve the efficiency of health services. Nonparametric Data Envelopment Analysis (DEA) is used in the measurement of hospital technical efficiency whilst the DEA-Malmquist index is used in the measurement of hospital total factor productivity change. The Hospital Management Information System launched in 1997 is the source of the data for this study. The results indicate the existence of different degrees of technical and scale inefficiency in Uganda’s district referral hospitals over the sample period. There were productivity losses for the sample hospitals which are largely due to technological regress rather than technical inefficiency. Thus, changes in technology are needed if the hospitals are to become more productive, for instance through improved diagnosis tests, hospital information management. The findings illustrate one of the advantages of the frontier efficiency technique, namely the ability to identify the degree of emphasis that should be placed on improving technical efficiency vis-à-vis technological change. The study adds to the existing literature on health facility efficiency but additionally incorporates patient deaths in the measurement of hospital technical efficiency. Additionally, heterogeneity in the patient load is controlled for via a length of stay-based case-mix index. Quality of care was incorporated into the analysis by means of patient deaths. Super-efficiency was conducted to further distinguish between the technically efficient hospitals. To construct confidence intervals for individual hospitals technical efficiency scores, nonparametric bootstrapping was conducted. The efficiency vectors yielded have ready uses by policymakers in the hospital sector. Indicators of the relative efficiency of hospitals are needed to gauge whether hospital cost-containment efforts are succeeding, amongst other uses.