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11. State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India

Author:
Victoria Fan, Anup Karan, and Ajay Mahal
Publication Date:
06-2012
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In 2007, the state of Andhra Pradesh in southern India began rolling out the Aarogyasri health insurance to reduce catastrophic health expenditures in households “below the poverty line.” We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that, within the first year of implementation, Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.
Topic:
Health, Poverty, and Health Care Policy
Political Geography:
India, Asia, and Andhra Pradesh

12. A Commitment to Vaccination Index: Measuring Government Progress toward Global Immunization

Author:
Amanda Glassman, Denizhan Duran, and Juan Ignacio Zoloa
Publication Date:
08-2012
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Vaccination is among the most cost-effective health interventions and has attracted ever greater levels of investment from public and private funders. However, some countries, mainly populous lower-middle-income countries, are lagging behind in vaccination financing and performance.
Topic:
Development, Foreign Aid, and Health Care Policy

13. Antiretroviral Therapy Awareness and Risky Sexual Behaviors: Evidence from Mozambique

Author:
Mead Over, Damien de Walque, and Harounan Kazianga
Publication Date:
01-2011
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper studies the effect of increased access to antiretroviral therapy on risky sexual behavior, using data collected in Mozambique in 2007 and 2008. The survey sampled both households of randomly selected HIV-positive individuals and households from the general population. Controlling for unobserved individual characteristics, the findings support the hypothesis of disinhibition behaviors, whereby risky sexual behaviors increase in response to the perceived changes in risk associated with increased access to antiretroviral therapy. Furthermore, men and women respond differently to the perceived changes in risk. In particular, risky behaviors increase for men who believe, wrongly, that AIDS can be cured, while risky behaviors increase for women who believe, correctly, that antiretroviral therapy can treat AIDS but cannot cure it. The findings suggest that scaling up access to antiretroviral therapy without prevention programs may not be optimal if the objective is to contain the disease, since people would adjust their sexual behavior in response to the perceived changes in risk. Therefore, prevention programs need to include educational messages about antiretroviral therapy and address the changing beliefs about HIV in the era of increasing antiretroviral therapy availability.
Topic:
Education and Health Care Policy
Political Geography:
Africa

14. Food Crisis, Household Welfare, and HIV/AIDS Treatment: Evidence from Mozambique

Author:
Mead Over, Damien de Walque, Harounan Kazianga, and Julia Vaillant
Publication Date:
01-2011
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Using panel data from Mozambique collected in 2007 and 2008, the authors explore the impact of the food crisis on welfare of households living with HIV/AIDS. The analysis finds that there has been a real deterioration of welfare in terms of income, food consumption, and nutritional status in Mozambique between 2007 and 2008, among both HIV and comparison households. However, HIV households have not suffered more from the crisis than others. Results on the evolution of labor-force participation suggests that initiation of treatment and better services in health facilities have counterbalanced the effect of the crisis by improving the health of patients and their labor-force participation. In addition, the authors look at the effect of the change in welfare on the frequency of visits to health facilities and on treatment outcomes. Both variables can proxy for adherence to treatment. This is a particularly crucial issue as it affects both the health of the patient and public health because sub-optimal adherence leads to the development of resistant forms of the virus. The authors find no effect of the change in welfare on the frequency of visits, but they do find that people who experienced a negative income shock also experienced a reduction or a slower progress in treatment outcomes.
Topic:
Food and Health Care Policy
Political Geography:
Africa

15. IDA at 65: Heading Toward Retirement or a Fragile Lease on Life?

Author:
Todd Moss and Benjamin Leo
Publication Date:
03-2011
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Even under conservative assumptions, IDA will likely face a wave of country graduations by 2025. We project that it will lose more than half of its client countries and that the total population living in IDA-eligible countries will plunge by two-thirds. The remaining IDA-eligible countries will be significantly smaller in size and overwhelmingly African, and a majority are currently considered fragile or post-conflict. This drastically altered client base will have significant implications for IDA's operational and financial models. We conclude with three possible options for IDA and recommend that World Bank shareholders and management begin frank discussions on its future sooner rather than later.
Topic:
Demographics, Development, Health, World Bank, and Health Care Policy
Political Geography:
Africa