Lida Fan

Modelling prenatal health care utilization in Tajikistan using a two-stage approach: implications for policy and research.

Since the transition from a centrally planned to a market economy, Tajikistan has witnessed a high rate of child and maternal mortality, a decline in the birth rate and a significant drop in public expenditures on health care. Against this backdrop, this paper analyses the determinants of prenatal health care utilization using Andersens behavioural model, which has been modified to the context of Tajikistan. We applied a two-stage sequential model to data drawn from a nationally representative survey. Binary logit regression is used to predict and explain the probability of using prenatal health care services, while negative binomial regression is used to predict and explain the frequency of using these services. Findings suggest that higher educational attainment increases the utilization of prenatal care. Conversely, poverty, limited knowledge about matters related to sex, low quality of health care service, lack of public infrastructure, as well as absence of or long distance of travel to the nearest health facility, all reduce the utilization of prenatal health care. Health policy and research implications are presented and discussed.

Determinants of maternity health care utilization in Tajikistan: Learning from a national living standards survey

This study examines the demographic, economic, social, and geographic factors that help explain maternity health care utilization in Tajikistan, a low-income transitional country in Central Asia, based on a newly available nationally representative living standard survey. Two regression models, namely, a binomial logit model and a zero-inflated negative binomial (ZINB) model are estimated. The estimations of the two models show strikingly consistent results--the year of last childbirth, educational attainment, and the availability of public infrastructure are important predictors of maternity health care utilization. The results also signify an urgent need to overturn the current negative trend in maternity health care utilization. The findings also suggest that many determinants of maternity health care are outside the direct sphere of health care policies, indicating the need of cross-sectional policies in addressing maternity health care utilization, for example, policies and strategies that include contributions from other sectors.

Does prenatal healthcare improve child birthweight outcomes in Azerbaijan? Results of the national Demographic and Health Survey

This paper evaluates the effectiveness of prenatal healthcare in Azerbaijan on improving child birthweight using the 2006 Azerbaijan Demographic and Health Survey, a nationally representative survey of reproductive aged women. Two measures of prenatal health utilization are used to measure healthcare input-the number of prenatal visits and the quality index of health care. Endogeneity in prenatal healthcare utilization is controlled by 2SLS regression. Selection bias of probability of child being weighed is controlled by a binomial probit regression. We found that prenatal healthcare does improve child birthweight. The results of the 2SLS suggest that an additional prenatal visit increases birthweight by about 26g, or approximately 0.8% of the raw mean of birthweight in the country. Likewise, a unit increase in quality of prenatal healthcare increases birthweight by 21g or by approximately 1.3% of the birthweight. In general, the magnitude of prenatal care impact in Azerbaijan is comparable with that in other countries.

Comparing and contrasting poverty reduction performance of social welfare programs across jurisdictions in Canada using Data Envelopment Analysis (DEA): an exploratory study of the era of devolution.

In the mid-1990s, the responsibilities to design, implement, and evaluate social welfare programs were transferred from federal to local jurisdictions in many countries of North America and Europe through devolution processes. Devolution has caused the need for a technique to measure and compare the performances of social welfare programs across multiple jurisdictions. This paper utilizes Data Envelopment Analysis (DEA) for a comparison of poverty reduction performances of jurisdictional social welfare programs across Canadian provinces. From the theoretical perspective, findings of this paper demonstrates that DEA is a promising method to evaluate, compare, and benchmark poverty reduction performance across multiple jurisdictions using multiple inputs and outputs. This paper demonstrates that DEA generates easy to comprehend composite rankings of provincial performances, identifies appropriate benchmarks for each inefficient province, and estimates sources and amounts of improvement needed to make the provinces efficient. From a practical perspective the empirical results presented in this paper indicate that Newfoundland, Prince Edwards Island, and Alberta achieve better efficiency in poverty reduction than other provinces. Policy makers and social administrators of the ineffective provinces across Canada may find benefit in selecting one of the effective provinces as a benchmark for improving their own performance based on similar size and structure of population, size of the budget for social programs, and traditions with administering particular types of social programs.

Devolution and the Poverty Reduction Effectiveness of Canada's Provincial Social Welfare Programs: Results from a Time-Series Investigation of a Canadian National Survey

The process of devolution initiated in the mid-1990s dramatically changed the landscape of social welfare policy within Canada. This study assesses the impact of devolution on the poverty reduction effectiveness of Canadas provincial social welfare programs by analyzing data obtained from a series of nationally representative surveys for the years 1996 to 2005. The primary finding was that the overall poverty reduction effectiveness of the provinces declined during a decade of devolution. The implications of the studys findings are discussed, including their relevance for advocacy efforts aimed at reducing poverty and the future direction of research on social welfare policy.

Comparison of inequality reduction and income security in Canada from a mixed to neo-liberal welfare regime: micro-data simulations and policy implications

Using micro-data from two nationally representative surveys, we quantify and explain intertemporal evolution in inequality reduction effectiveness of income security programmes in Canada caused by change from a mixed to a neo-liberal welfare regime. The presented empirical evidence shows that the overall inequality reduction effectiveness of income security declined significantly as a result of regime change. The new neo-liberal welfare regime of income security in Canada is characterized by paradoxes of redistribution and by increased degrees of stratification.

The Effect of Maternal Healthcare on the Probability of Child Survival in Azerbaijan

This study assesses the effects of maternal healthcare on child survival by using nonrandomized data from a cross-sectional survey in Azerbaijan. Using 2SLS and simultaneous equation bivariate probit models, we estimate the effects of delivering in healthcare facility on probability of child survival taking into account self-selection into the treatment. For women who delivered at healthcare facilities, the probability of child survival increases by approximately 18%. Furthermore, if every woman had the opportunity to deliver in healthcare facility, then the probability of child survival in Azerbaijan as a whole would have increased by approximately 16%.

A Multilevel Logit Estimation on the Determinants of Utilization of Preventive Health Care and Healthy Lifestyle Practice in China

The purpose of this study is to provide policy implications by estimating the individual and community level determinants of preventive health-care utilization in China based upon data from the China Health and Nutrition Survey. Two different frameworks, a human capital model and a psychological-behavioral model, are tested using a multilevel logit estimation. The results demonstrate different patterns for medical and nonmedical preventive activities. There is a strong correlation between having medical insurance and utilizing preventive health services. For the usage of medical-related preventive health care (MP), age, gender, education, urban residence, and medical insurance are strong predictors. High income did not provide much of an increase in the usage level of MP, but the lack of income was a huge obstacle for low-income people to overcome. Community variation in number of facilities accounted for about one third of the total variation in the utilization of MP. The utilization of MP in China remains dependent upon the individuals social-economic conditions.

Effects of the 2008 global financial crisis on population health

We compare the transmission channels through which the 2008 global financial crisis affected health. We find that postponing or skipping visits to the doctor after falling ill and stopping buying regular medication had the strongest negative effects on health, followed by a reduced consumption of staple foods, utilities being cut, being forced to move, and having to sell assets. In comparison, experiencing cuts in TV, phone, and internet services, as well as delaying payments for utilities had relatively weaker negative impacts. In contrast, having a household head or household member lose a job also had negative effects on health status, although this effect was relatively lower. Finally, a reduced flow of remittances had the weakest negative effect.

A healthy weight improves life satisfaction

In this study, we examine the effects of having a healthy weight in form of a healthy body mass index (BMI) on life satisfaction using the data from a diverse sample of 27 post-communist transitional countries. We find that a healthy BMI significantly raises life satisfaction, while an increase in BMI reduces life satisfaction. We also find that the positive effect of a healthy BMI on life satisfaction substantially diminishes as the political and economic situation improves. Equally, the positive effect of healthy BMI on life satisfaction is considerably lower for those who exhibit higher levels of institutional trust and express trust in government, parliament, and political parties. Classic regression models such as ordinary least squares (OLS) and ordered probit significantly underestimate the true effect of healthy BMI on life satisfaction. Such results suggest that unobserved confounders, measurement error, or their interplay appear to be the main source (s) of bias that eventually lead to a significant underestimation of the true effect of BMI on life satisfaction through classic regression models.