Vortragssitzung
Health Care in Developing Countries
Vorträge
Covid-19 Crisis, instability of preferences and media exposure: anatural experiment from urban Burkina Faso
Laurène PETITFOUR, Heidelberg Institute for Global Health
Einleitung / Introduction
Preferences influence a large range of behaviors that impact various outcomes:delay in healthcare seeking, savings, health insurance enrollment. As some behaviors may appear as sub-optimal at first sight, their understanding is essential to propose some accurate nudges and incentive mechanisms to spur healthy behaviors .This is even more important in developing countries where insurance schemes are not all compulsory and rely on individual choice and where people are likely to suffer more serious consequences than in developed countries when adverse events occur. Standard decision theory in economics is rooted in the principle that preferences - in the same vein as tastes - are immutable. However, given the growing evidence that preferences change over time in a substantial way (due to age or shocks), it seems unlikely that sizable variations in preferences are only due to measurement errors. Our paper relates to the burgeoning stream of research investigating the stability of risk and time preferences after a shock in developing countries, using the first wave of the Covid-19 in Burkina Faso as the external shock.
Methode / Method
We make use of an original panel dataset conducted in January 2020 (before any event) and in June 2020 (just after the removal of strong economic measures) among women informal workers in Ouagadougou, Burkina Faso. Our empirical strategy uses individual fixed-effect on a balanced panel of 871 women to isolate the specific effect of the Covid-19 crisis on the variation in risk and time attitudes over these six months.
Ergebnisse / Results
In line with the literature, results show that risk aversion did change over the period, in both gain (13%) and loss (-47%) domains,while impatience increases by 9%. We also find that higher exposure to media strengthens the instability of preferences: the more the respondent is informed, the higher its risk and time preferences vary. The same is observed when his source of information comes from the governmentor a social network (Facebook and WhatsApp)
Zusammenfassung / Conclusion
This study uses the Covid-19 crisis to empirically address whether risk and time preferences change in reaction to a modification in the environment. We contribute to the literature on preference instability by using an identification strategy that allows ruling out alternative explanations for differences in preferences among a population. Indeed, the salience of the Covid-19 crisis over a well-identified period represents an unexpected, exogenous and sharp change in the environment.
AutorInnen
Delphine Boutin, Université de Bordeaux
Haris Megzari, Université de Bordeaux
Laurène Petitfour, Heidelberg Institute for Global Health
Program costs of longer and shorter tuberculosis drug regimens and drug import: A modelling study for Karakalpakstan, Uzbekistan
Nicolas Paul, Heidelberg Institute of Global Health, Universität Heidelberg; Charité – Universitätsmedizin Berlin
Stefan Kohler, Heidelberg Institute of Global Health, Universität Heidelberg; Charité – Universitätsmedizin Berlin
Einleitung / Introduction
The introduction of new and often shorter tuberculosis (TB) drug regimens affects TB program costs.
Methode / Method
Based on 2016–2020 patient numbers, we modelled drug purchase and import costs for a TB program in Karakalpakstan, Uzbekistan, for 20-months, 9-months, and 4–6-months drug regimens for drug-susceptible (DS)-TB and multidrug-resistant (MDR)-TB treatment.
Ergebnisse / Results
On average, 2,225 (standard deviation [SD] 374) people per year started TB treatment in the program; 30% (SD 2.1) were diagnosed with drug-resistant forms of TB. Transitioning from a 6-months to a 4-months DS-TB drug regimen was estimated to increase the TB program’s average annual drug costs from $65 K (SD 10) to $363 K (SD 57) and drug import costs from $6.2 K (SD 1.0) to 10 K (SD 1.6). Transitioning from a 20-months, all-oral MDR-TB drug regimen to a 9-months MDR-TB drug regimen with an injectable antibiotic decreased the annual drug costs from $1.9 M (SD 0.38) to $325 K (SD 64) and had no significant effect on the program’s drug import cost ($28 K [SD 5.6] versus $27 K [SD 5.4]). Purchasing ($658 K [SD 130]) and importing ($2,5 K [SD 0.49]) a 6-months, all-oral MDR-TB regimen cost more than the 9-months MDR-TB regimen but less than the 20-months, all-oral MDR-TB regimen.
Zusammenfassung / Conclusion
At current prices, the cost of TB programs with high drug resistance rates could decline by introducing new TB drug regimens, whereas introducing new drug regimens in TB programs with low rates of drug resistance results in a program cost increase.
AutorInnen
Nicolas Paul, Heidelberg Institute of Global Health, Universität Heidelberg; Charité – Universitätsmedizin Berlin
Norman Sitali, Médecins Sans Frontières
Jay Achar, Department of Global Public Health, Karolinska Institutet
Stefan Kohler, Heidelberg Institute of Global Health, Universität Heidelberg; Charité – Universitätsmedizin Berlin
Weather shocks, recall bias and health: Evidence from rural Thailand
Soschia Karimi
Einleitung / Introduction
Negative consequences of weather shocks are most evident among poorer households in less developed areas. The associated losses of well-being are going to become even more pressing with the predicted increase in frequency and intensity of climatic disasters such as droughts. To reduce the effects of such shocks it is relevant to understand how those shocks affect health and what characteristics more resilient household’s exhibit. The aim of this study is twofold. First, we identify a recall bias with respect to droughts comparing survey data and objective data. Second, we analyse the effect of droughts on health in Thailand.
Methode / Method
First, to rule out the recurring problem with self-reported data, we test the robustness of our data with regard to recall bias. To do that, we combine self-reported survey data from the TVSEP with measured weather data from the ERA5. We show that the time interval since exposure has a significant impact on drought recall using a natural experiment. We use a difference-in-differences approach, comparing households in two provinces that are usually surveyed at the same time in the considered four waves. Due to random exclusion, the recall period for one province was extended to 36 instead of 12 months. Second, we analyse the effect of drought on health via a fixed-effects regression using a panel over seven waves and controlling for household characteristics, village and wave fixed-effects. Additionally, we identify attributes that are beneficial for the resilience to weather shocks.
Ergebnisse / Results
First, we find that the time interval between exposure and survey has a significant effect on the extent of a reporting bias. Shorter intervals result in more correct-reporting and less under-reporting of droughts. Second, our findings on the effect of droughts on health are in line with the existing literature. We see a negative impact of droughts on health. We also note that internet/smartphone availability is associated with a cushioning of the negative health impact of a drought. One possible channel is building and maintaining a network of individuals who do not live in the same district. Thus, when a shock occurs, the household can receive support from network members who were not affected by the shock.
Zusammenfassung / Conclusion
We analyse the impact of time interval since drought exposure on reporting biases and find that shorter time distances increase the data quality. Therefore, we conclude, time intervals of 12 months should be preferred over longer time intervals, when using self-reported weather data. Further, we analyse the impact of drought on health and consider possible resilience factors. In line with the literature, we find that drought has a negative impact on health. Additionally, we identify smartphone and internet use as potential resilience factors.
AutorInnen
Annika Herr, Leibniz Universität Hannover
Soschia Karimi, Leibniz Universität Hannover
Julian Wichert, Leibniz Universität Hannover
To make, buy, or do nothing: A costing study of medical equipment maintenance schemes in Nepal
Constantin Schmidt, Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
Einleitung / Introduction
About half of all medical devices in low- and lower-middle-income countries are currently non-operational because equipment maintenance is lacking. Thus, boosting the cost efficiency of equipment maintenance could greatly improve health service provision. We employ data from a pilot program in 19 public hospitals in Nepal between 2010 and 2014 to compare the total cost of three approaches to equipment maintenance: contracted-out vs. in-house vs. no maintenance. The contracted-out scheme employed a private contractor who monitored maintenance need and executed maintenance services.
Methode / Method
We use invoiced pilot program costs, device depreciation estimates from the literature, and hospital characteristics from Nepal’s Health Management Information System. We estimate net-present values for a three-year horizon, incorporating both fixed and operational cost. Operational costs include downtime cost measured as lost revenues due to non-working equipment.
Ergebnisse / Results
The contracted-out maintenance scheme shows a strong relative cost performance. Its cost after three years amount to 4,501,574 International Dollars Purchasing Power Parity (I$ PPP), only 90% of the cost with no maintenance. The contracted-out scheme incurs 670,288 I$ PPP and 3,765,360 I$ PPP in in fixed cost and operational cost, respectively. The cost for replacing broken devices is 1,920,467 I$ PPP lower with maintenance. In addition, after three years total cost of contracted-out maintenance is 489,333 I$ PPP (11%) below total cost of decentralized in-house maintenance. After ten years, contracted-out maintenance saves 2.5 million I$ PPP (18%) compared to no maintenance.
Zusammenfassung / Conclusion
We find contracted-out maintenance provides cost-efficient medical equipment maintenance in a lower-middle income context. Our findings contrast with studies from high- and upper-middle-income countries, which depict contexts with more in-house engineering expertise than in our study area. Since the per hospital fixed cost decrease with scheme size, it is recommendable to expand contracted-out maintenance to all public hospitals in Nepal.