Tapas Kundu

Economic Impact of Terminal Illness and the Willingness to Change It

OBJECTIVE To gather pilot data on the economic impact of terminal illness on families and on the feasibility of training caregivers as a method of stemming illness-related poverty. DESIGN Exploratory, descriptive study involving semistructured interviews with patient and caregiver dyads. SETTING Pallium India Palliative Care Clinic in Trivandrum, Kerala, India. PARTICIPANTS Eleven patient-caregiver dyads (22 individual participants) visiting Pallium India in 2008. METHODS Trained interviewers conducted face-to-face interviews consisting of 114 questions with the patient and caregiver separately. Questions covered topics of economic impact of illness on household, family, and individual. Questions included if the illness had so impacted families that they needed to sell assets or significantly reduce work and/or schooling. RESULTS All families reported that patients were obliged to give up work as a result of illness. In seven families, the caregiver also had to change work habits. All respondents stated illness had forced them to sell assets. Ten households reported that their children were obliged to miss school due to the illness. All respondents indicated they would use trained caregivers to help with the care burden if available. Nine respondents thought that use of trained caregivers would have reduced or prevented some of the households illness-related change. Nine caregivers said they would be interested in becoming a trained caregiver. CONCLUSION These data indicate that a definitive study would be feasible and would reveal how much assistance caregiver training could lend to household socio-economic resilience.

Conflict and Mobility: Resource Sharing Among Groups

We study a political competition between two groups, where the winner has the decision rights to allocate resources, like political parties deciding on sharing of patronage goods. What factors determine how resources are shared? We highlight an important force that affects distribution of resources, namely the ability to move between groups. In many contexts, group sizes are determined endogenously. For example, allocation of jobs based on party allegiance may influence individuals’ choices of switching party membership. We analyze how the ease of inter-group mobility affects resource allocation. One insight from existing literature is that the threat of conflict can also act as a constraint to how exploitative the elite can be. We investigate the combined effect of both factors. We show how inter-group mobility affects the possibility of conflict and in turn the extent of resource sharing? We find that sharing occurs in equilibrium. There are two reasons why the incumbent wants to shares resources with the opposition. First, if the incumbent retains too much surplus, it may attract switchers, which reduces the per capita share. Second, sharing resources increases the oppositions opportunity cost of engaging in conflict. There are thus two constraints on expropriation - the switching constraint and the conflict constraint. Optimal sharing is dictated by whether the constraint s bind. We also find a non-monotonic relationship between resource sharing and the cost of mobility. Our predictions are consistent with several stylized facts that cannot be explained by earlier models.