Zlatko Nikoloski

Did mass privatisation really increase post-communist mortality?

In this document, we describe more fully the methods and results summarized in our letter to The Lancet. We begin by presenting our replication of the cross-country analysis reported in Stuckler, King, and McKee (henceforth SKM). We then proceed to an alternative research design, where we explore the relationship between privatisation and mortality across Russian regions. Finally, we revisit the question of whether privatisation increased mortality, the only mechanism for which SKM provide evidence by which privatisation might have increased mortality.A recent article in the Lancet, by David Stuckler, Larry King and Martin McKee, investigated anew the fluctuations in adult male mortality rates that have come to characterise the so-called post-communist mortality crisis. Adopting a cross-country, time-series perspective the authors examined how the economic policy strategies of the 1990s impacted upon observed fluctuations in mortality. They conclude that the adoption of a strategy of rapid (mass) privatisation contributed to the adverse mortality trends. We subject that finding to closer scrutiny using the same data from which the Stuckler et al claim stems. We find that their claim that mass privatisation adversely affected male mortality trends in the post-Communist world does not stand up to closer examination. It is not supported empirically and is at odds with what we know about both transition in the post-communist world and about health trends over time in this region.

FINANCIAL SECTOR DEVELOPMENT AND INEQUALITY: IS THERE A FINANCIAL KUZNETS CURVE?

The existing empirical knowledge in the area of financial sector development and income inequality finds evidence for the theoretical work of Banerjee and Newman (1993) and Galor and Zeira (1993) who posit a simple, linear relationship between the two variables. In this paper, we subject the extant empirical knowledge to close scrutiny and point out to a potential dynamic and endogenous relationship between financial sector development and inequality. By using dynamic multivariate panel data analysis on a carefully selected dataset of income inequality data for developed and developing countries spanning the period 1962-2006, we find robust empirical evidence for the existence of an inverted U-curve relationship between financial sector development and income inequality. The results are robust to inclusion of different control variables and different lag structure in the estimation method. In that token, we confirm the theoretical stipulations of Greenwood and Jovanovic (1990) for an inverted U-curve relationship between the financial sector and income inequality.

Corruption, inequality and population perception of healthcare quality in Europe

BackgroundEvaluating the quality of healthcare and patient safety using general population questionnaires is important from research and policy perspective. Using a special wave of the Eurobarometer survey, we analysed the general population’s perception of health care quality and patient safety in a cross-country setting.MethodsWe used ordered probit, ordinary least squares and probit analysis to estimate the determinants of health care quality, and ordered logit analysis to analyse the likelihood of being harmed by a specific medical procedure. The models used population weights as well as country-clustered standard errors.ResultsWe found robust evidence for the impact of socio-demographic variables on the perception of quality of health care. More specifically, we found a non-linear impact of age on the perception of quality of health care and patient safety, as well as a negative impact of poverty on both perception of quality and patient safety. We also found robust evidence that countries with higher corruption levels were associated with worse perceptions of quality of health care. Finally, we found evidence that income inequality affects patients’ perception vis-à-vis safety, thus feeding into the poverty/health care quality nexus.ConclusionsSocio-demographic factors and two macro variables (corruption and income inequality) explain the perception of quality of health care and likelihood of being harmed by adverse events. The results carry significant policy weight and could explain why targeting only the health care sector (without an overall reform of the public sector) could potentially be challenging.

Satisfaction and responsiveness with health-care services in Qatar—evidence from a survey

BACKGROUND Satisfaction and responsiveness with health care are some of the main outcome variables of a health system. Although health outcomes have been studied in countries with different levels of economic development, there is limited information on the health provision/satisfaction/responsiveness nexus in countries where rapid transitions from middle to high-income status have occurred. METHODS Using a 2012 survey conducted in Qatar (amongst both Qatari and non-Qatari respondents), we analysed satisfaction and responsiveness of health care. The sample consisted of 4083 respondents. We use logit analysis [as well as robustness checks involving ordered logit, ordered probit, ordinary least squares (OLS) and probit analysis] in order to estimate the determinants of satisfaction and responsiveness. RESULTS Both, satisfaction and responsiveness rates were high. Gender, nationality and, to some extent, income and age were significant sociodemographic determinants of satisfaction, with non-Qataris and females, having higher levels of satisfaction. Cost, previous experience with the same health provider and provision of medical insurance for a particular health provider were the attributes significantly correlated with general satisfaction. The results are consistent when the analysis is applied to the correlates of responsiveness. CONCLUSIONS Sociodemographic factors explain the satisfaction with quality of health care in the state of Qatar (both from the general population point of view and from the patient point of view).

Impact of financial crises on poverty in developing world: an empirical approach

ABSTRACT This article adopts a cross-country perspective to analyse the short term effects of currency, banking and debt crises on the poverty headcount ratio and the poverty gap (as measured by the World Bank), employing multivariate fixed-effects panel data analysis. The findings suggest that currency crises most significantly exacerbate both the incidence and depth of poverty in the short run. Banking crises are associated with an increase in the depth of poverty but not the incidence while there is no direct effect of sovereign debt crises. Given the low level of significance, the results are far from conclusive and offer only partial indications of the crises-poverty nexus.

Democracy and Income Inequality: Revisiting the Long- and Short-Term Relationship

This paper studies the relationship between democracy andincome inequality in long- and short/medium-run. Using appropriate econometrictechniques on both, averaged and panel data for the period 1962-2006, we findno evidence that democracy is associated with tighter income distribution. Ourresults are robust to different specification techniques, to exclusion ofdeveloped as well as the transition countries. We speculate that the different(and opposing) transmission mechanisms, as well as the nature and thedefinition of the democracy variables (both Polity IV and Freedom House)influence our results. Improvement of conceptualization and measurement of democracycould shed further light onto the democracy-inequality nexus.

Estimating the Size of External Effects of Energy Subsidies in Transport and Agriculture

It is widely accepted that the costs of under-pricing energy are large, whether in advanced or developing countries. This paper explores how large these costs can be by focussing on the size of the external effects that energy subsidies in particular generate in two important sectors – transport and agriculture – in two MENA countries, Egypt (transport) and Yemen (agriculture). Our focus is mainly on the costs associated with congestion and pollution as well the impact of under-priced energy for depletion of scarce water resources including through crop selection. Quantifying the size of external effects in developing countries has received relatively little analytical attention, although there is a significant body of literature for the advanced world. By building on earlier research, as well as employing the UN ForFITS model we are able to provide indicative estimates of the external costs of energy subsidies, as manifested in congestion and pollution. Our estimates using simulations indicate that these costs could be materially reduced by elimination or reduction of energy subsidies. We are also able to describe the impact of energy subsidies on water consumption in a region where water resources are particularly limited. As such, our findings provide further evidence of the adverse and significant consequences of subsidising energy.

Equity of access to maternal health interventions in Brazil and Colombia: a retrospective study

BackgroundReducing maternal mortality is a top priority in Latin American countries. Despite the progress in maternal mortality reduction, Brazil and Colombia still lag behind countries at similar levels of development.MethodsUsing data from the Demographic Health Survey, this study quantified and compared, by means of concentration indices, the socioeconomic-related inequity in access to four key maternal health interventions in Brazil and Colombia. Decomposition analysis of the concentration index was used for two indicators – skilled attendance at birth and postnatal care in Brazil.ResultsCoverage levels of the four key maternal health interventions were similar in the two countries. More specifically, we found that coverage of some of the interventions (e.g. ante-natal care and skilled birth assistance) was higher than 90% in both countries. Nevertheless, the concentration index analysis pointed to significant pro-rich inequities in access in all four key interventions in both countries. Interestingly, the analysis showed that Colombia fared slightly better than Brazil in terms of equity in access of the interventions studied. Finally, the decomposition analysis for the presence of a skilled attendant at birth and postnatal care in Brazil underlined the significance of regional disparities, wealth inequalities, inequalities in access to private hospitals, and inequalities in access to private health insurance.ConclusionsThere are persistent pro-rich inequities in access to four maternal health interventions in both Brazil and Colombia. The decomposition analysis conducted on Brazilian data suggests the existence of disparities in system capacity and quality of care between the private and the public health services, resulting in inequities of access to maternal health services.

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly

Chinas recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between Chinas health insurance and out-of-pocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low- and medium-income individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that Chinas health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system.

Obesity in Middle East

The Middle East and North Africa region (MENA) encompasses 18 countries at various levels of economic development – high-income (Qatar, Saudi Arabia), upper-middle-income (Jordan, Morocco), and lower-middle-income countries (Yemen). As in the rest of the world, rising obesity prevalence has also been documented in the MENA countries, with roughly one fifth of the adult population in the region considered as obese. Against this background, this article (i) documents the prevalence of obesity in the region (both from the literature and official statistical sources), (ii) identifies the major correlates of obesity, and (iii) assesses and documents the literature that links obesity with some of the most prevalent noncommunicable diseases (inter alia, diabetes and cardiovascular diseases). We argue that the levels of obesity in the region are high and still increasing, with gender, age, income, education, nutrition patterns, and urbanization acting as the most prominent and robust correlates of obesity in the MENA region. Finally we argue that, in the context of MENA countries, there is robust link between obesity and certain chronic conditions (e.g., diabetes).