Noemi Pace

Are Employers Discriminating with Respect to Weight? European Evidence using Quantile Regression

The aim of this research is to investigate the relationship between obesity and wages, using data for nine countries from the European Community Household Panel (ECHP) over the period 1998-2001. We improve upon the existing literature by adopting a Quantile Regression approach to characterize the heterogenous impact of obesity at different points of the wage distribution. Our results show that (i) the evidence obtained from mean regression and pooled analysis hides a significant amount of heterogeneity as the relationship between obesity and wages differs across countries and wages quantiles and (ii) cultural, environmental or institutional settings do not seem to be able to explain differences among countries, leaving room for a pure discriminatory effect hypothesis.

Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study

BackgroundThe cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty.MethodsWe used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India). We analysed expenditure by socio-economic status (SES), calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing).ResultsA high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly) regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive.ConclusionsHigh expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective is to increase institutional deliveries without forcing households deeper into poverty, these inequities will need to be addressed. Reducing out-of-pocket payments and better regulating informal payments should have direct benefits for the most poor. Alternatively, targeted schemes aimed at assisting the most poor in coping with maternal spending (including indirect spending) could reduce the household impact of high costs.

Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study

Womens groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 womens group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the womens groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the womens group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Womens groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit.

Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care

BackgroundThere is considerable interest in exploring the potential of social health insurance in Africa where a number of countries are currently experimenting with different approaches. Since these schemes have been introduced recently and are continuously evolving, it is important to evaluate their effectiveness in the enhancement of health care utilization and reduction of out-of-pocket expenses for potential policy suggestions.ObjectiveTo investigate how the National Health Insurance Schemes (NHIS) in Ghana affects the utilization of maternal health care services and medical out-of-pocket expenses.MethodsWe used nationally-representative household data from the Ghana Demographic and Health Survey (GDHS). We analyzed the 2014 GDHS focusing on four outcome variables, i.e. antenatal check up, delivery in a health facility, delivery assisted by a trained person and out-of-pocket expenditure. We estimated probit and bivariate probit models to take into account the issue of self selection into the health insurance schemes.ResultsThe results suggest that, also taking into account the issue of self selection into the health insurance schemes, the NHIS enrollment positively affects the probability of formal antenatal check-ups before delivery, the probability of delivery in an institution and the probability of being assisted during delivery by a trained person. On the contrary, we find that, once the issue of self-selection is taken into account, the NHIS enrollment does not have a significant effect on out-of-pocket expenditure at the extensive margin.ConclusionSince a greater utilization of health-care services has a strong positive effect on the current and future health status of women and their children, the health-care authorities in Ghana should make every effort to extend this coverage. In particular, since the results of the first step of the bivariate probit regressions suggest that the educational attainment of women is a strong determinant of enrollment, and those with low education and unable to read are less likely to enroll, information on the NHIS should be disseminated in ways that reach those with little or no education. Moreover, the availability of government health facilities in a region is associated with higher likelihood of enrollment in the NHIS. Accordingly, extending geographical access is an important strategy for expanding NHIS membership and improving access to health-care.

Experience and Gender Effects in an Acquiring-a-Company Experiment Allowing for Value Messages

This paper focuses on a bargaining experiment in which the privately informed seller of a company sends a value message to the uninformed potential buyer who then proposes a price for acquiring the company. Participants are constantly in the role of either seller or buyer and interact over 30 rounds with randomly changing partners in the other role. We test how overstating the value of the company, underpricing the received value message and acceptance of price offers are affected by experience and gender (constellation). Like in our companion paper on single play (Di Cagno et al. 2015) we control via treatments for awareness of gender (constellation). One main hypothesis is that gender (constellation) matters but that the effects become weaker with more experience and that the main experience effects apply across gender (constellations).

The Chinese health care system reforms and household saving patterns: some stylized facts.

Abstract: This chapter aims to evaluate the relationship between one of the recent healthcare reforms in the People’s Republic of China and household decisions both in terms of out-of-pocket expenditure and saving. Evidence on the results achieved by reforms of the health insurance sector in terms of reducing out-of-pocket medical expenditure is still uncertain and contradictory, and very little is known about the effect of these measures on the consumption and saving behaviour of the Chinese population. To shed light on this issue we use data collected by Chinese Household Income Project surveys (CHIPs), through a series of questionnaire-based interviews conducted in urban areas in 1995 and 2002. Our descriptive analysis suggests that there is a positive relationship between public health insurance coverage and household saving. This empirical evidence suggests that public insurance coverage is ineffective as a source of protection against income losses and might induce households to save more.

One plus one can be greater than two: Evaluating synergies of development programmes in Malawi

ABSTRACT This paper investigates the interplay between the Social Cash Transfer Programme (SCTP) and the Farm Input Subsidy Programme (FISP) in Malawi. We take advantage of data collected from a 17-month evaluation of a sample of households eligible to receive SCTP, which also provided information about inclusion into FISP. We estimate two types of synergies: i) the complementarity between SCTP and FISP, that is whether the impact of both interventions run together is larger than the sum of the impacts of these interventions when run separately, and ii) the incremental impact of receiving FISP when a household already receives SCTP, as well as the incremental impact of receiving SCTP when a household already receives FISP. The analysis shows that there are synergies between the two policy interventions, mainly in terms of incremental impacts of each programme over the other, in increasing expenditure, agricultural production and livestock.

Does “soft conditionality” increase the impact of cash transfers on desired outcomes? Evidence from a randomized control trial in Lesotho

Cash transfers programs have been shown to have positive effects on a variety of outcomes. While much of the literature focuses on the role of conditionality in achieving desired impact, this paper focuses on the role of ‘soft conditionality’ implemented through both ‘labeling’ and ‘messaging’ in evaluating the impact of the Child Grants Program in Lesotho, an unconditional cash transfer targeting poor households with orphans and vulnerable children. Beneficiary households received a clear message that the transfer should be spent on the interest and needs of children. Our findings are based on a randomized experiment and suggest that ‘soft conditionality’ does play a strong role in increasing expenditure for children, especially on education, clothing and footwear. Results indicate in fact that transfer income is spent differently from general income as it exerts both an income and a substitution effect. This behavioral change is confirmed by comparing the ex-ante expected behaviors with the ex-post actual response to the program. We find that for expenditure categories linked to the wellbeing of children the ex-post response was much higher than the ex-ante expected behavior.

To Switch or Not to Switch Payment Scheme? Determinants and Effects in a Bargaining Game

The incentive scheme selected in a laboratory experiment might trigger different type of behavior in participants. This paper is an attempt to screen the strategies adopted by agents in a bargaining game when buyer and seller have partly conflicting interests and are asymmetrically informed. We allow participants to choose the incentive scheme through which they will be paid at the end of the experiment controlling for past experience and individual characteristics. It is well known that payment method is highly correlated to the risk preferences shown by individuals, but little research is devoted to the analysis of the behavior induced by Random Lottery Incentive scheme (RLI for short) and Cumulative Scheme payment (CS for short) both on individual and social results. This paper aims to fill the gap.

Changes in individual and/or aggregate?

The majority of papers reporting the results of experimental tests on individual behaviour concentrate on the average or aggregate behaviour of the subjects, even though different subjects may exhibit different kinds of behaviour. At the same time, it is well known that subjects are noisy in their responses and thus may change their behaviour during an experiment. The question then arises as to whether this noise causes average behaviour to change during an experiment. We take the data from an experiment on behaviour under ambiguity, which try to identify which preference functional subjects are using, and analyse it in two halves. We find that, while some individual preferences seem to change from the first to the second half, on average, preferences are unchanged (though there is a reduction in the noise exhibited by subjects in the second half). This is a reassuring message for those who want to draw inferences from experiments.