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61. Principal-Agent Problems in Health Care: Evidence from Prescribing Patterns of Private Providers in Vietnam

Publication Date:
12-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
The principal-agent problem in health care asserts that providers, being imperfect agents for patients, will act to maximize their profits at the expense of the patients' interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers' actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of the private providers. We show that (1) private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile; (2) private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and (3) patients' education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers. Our hypotheses were supported with evidence from Vietnam National Health Survey 2001 and 2002, the first and, so far, only comprehensive health survey in the country.
Topic:
Health and Human Welfare
Political Geography:
Asia, Australia/Pacific, and Southeast Asia

62. The Role of Women's Empowerment and Domestic Violence in Child Growth and Undernutrition in a Tribal and Rural Community in South India

Author:
Kavita Sethuraman
Publication Date:
02-2008
Content Type:
Working Paper
Institution:
United Nations University
Abstract:
Moderate undernutrition continues to affect 46 per cent of children under 5 years of age and 47 per cent of rural women in India. Women's lack of empowerment is believed to be an important factor in the persistent prevalence of undernutrition. In India, women's empowerment often varies by community, with tribes sometimes being the most progressive. This paper explores the relationship between women's empowerment, domestic violence, maternal nutritional status, and the nutritional status and growth over six months in children aged 6 to 24 months in a rural and tribal community. This longitudinal observational study undertaken in rural Karnataka, India included tribal and rural subjects. Structured interviews with mothers were conducted and anthropometric measurements were obtained for 820 mother-child pairs, the follow-up rate after 6 months was 82 per cent. The data were analyzed by multivariate regression. Some degree of undernutrition was seen in 83.5 per cent of children and 72.4 per cent of mothers in the sample, moreover the prevalence of undernutrition increased among children at follow up. Domestic violence was experienced by 34 per cent of mothers in the sample. In multivariate analysis, biological variables explained most of the variance in nutritional status and child growth, followed by health-care seeking and women's empowerment variables; socio-economic variables explained the least variance. Women's empowerment variables were significantly associated with child nutrition on enrolment and child growth at follow-up. At follow-up, mother's prior lifetime experience of physical violence significantly undermined child growth in terms of weight-for-age, and older age at marriage and high mobility of mothers predicted less stunting in their children. In addition to the known investments needed to reduce undernutrition, improving women's nutrition, promoting gender equality, empowering women, and ending violence against women could further reduce the prevalence of undernutrition in this segment of the Indian population.
Topic:
Gender Issues and Health
Political Geography:
India and Asia

63. The Determinants of Child Weight and Height in Sri Lanka: A Quantile Regression Approach

Author:
Harsha Aturupane, Anil B. Deolalikar, and Dileni Gunewardena
Publication Date:
05-2008
Content Type:
Working Paper
Institution:
United Nations University
Abstract:
Reducing child malnutrition is a key goal of most developing countries. To combat child malnutrition with the right set of interventions, policymakers need to have a better understanding of its economic, social and policy determinants. While there is a large literature that investigates the determinants of child malnutrition, it focuses almost exclusively on mean effects of these determinants. However, socioeconomic background variables and policy interventions may affect child nutrition differently at different points of the conditional nutritional distribution. Using quantile regressions, this paper explores the effect s of variables such as a child's age, sex and birth order; household expenditure per capita; parental schooling; and infrastructure on child weight and height at different points of the conditional distributions of weight and height using data from Sri Lanka's Demographic and Health Survey. Results indicate that OLS estimates can be misleading in predicting the effects of determinants at the lower end of the distributions of weight and height. For example, even though on average Sri Lankan girls are not nutritionally-disadvantaged relative to boys, among children at the highest risk of malnutrition girls are disadvantaged relative to boys. Likewise, although expenditure per capita is associated with strong nutritional improvement on average, it is not a significant determinant of child height or weight at the lower end of the distribution. Similarly, parental education, electricity access, and the availability of piped water have larger effect son child weight and height at the upper quantiles than at the lower quantiles. The policy implication is that general interventions—parental schooling, infrastructure and income growth—are not as effective for children in the lower tail of the conditional weight and height distributions. These children, who are at the highest risk of malnutrition, are likely to need specialized nutritional interventions.
Topic:
Development, Education, and Health
Political Geography:
Asia and Sri Lanka

64. No Way Out: An Assessment of the Romani Community in Georgia

Author:
David Szakonyi
Publication Date:
02-2008
Content Type:
Working Paper
Institution:
European Centre for Minority Issues
Abstract:
The Romani community is the most marginalized and disadvantaged ethnic community in Georgia. Although accurate estimates are hard to establish, the population is thought to number up to 1,500 persons, living in multiple small settlements across Georgia. Extreme poverty, unemployment, lack of education and health care, and isolation from larger society comprise several of the major problems the community as a whole is facing. The overall situation for the Roms in Georgia has significantly deteriorated since the Soviet period, leaving the population practically devoid of any means to lift themselves out of their often devastating circumstances.
Topic:
Education, Ethnic Conflict, Health, and Poverty
Political Geography:
Europe, Asia, Soviet Union, and Georgia

65. Incentives in China's Healthcare Delivery System

Author:
Karen Eggleston
Publication Date:
10-2008
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
The economic approach of comparative and historical institutional analysis (Aoki 2001, Greif 2006) has virtually never been used in theoretical studies of healthcare incentives. This paper seeks to help fill this gap by exploring the explanatory power of such an approach for understanding incentives in China's healthcare delivery system. It focuses on positive analysis of why China's health system incentives evolved the way they did. The first section analyzes the institution of physician dispensing (MDD) and reforms toward separation of prescribing from dispensing (SPD), in historical and comparative perspective. It shows, for example, how MDD was a self-reinforcing institution; the longer a society remains under MDD, the higher the associated costs of supplier-induced demand can be before implementing SPD becomes the efficient self-enforcing social institution. Rapid technological change and adoption of universal coverage are likely to trigger SPD reforms. The second section seeks to explain the pattern and impact of price regulation and hospital payment reforms in contemporary China, which also reflect the legacy of MDD.
Topic:
Government, Health, and Human Welfare
Political Geography:
China, Israel, and Asia

66. The Effect of Informal Caregiving on Labor Market Outcomes in South Korea

Author:
Young Kyung Do
Publication Date:
12-2008
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Embedded in traditional culture perpetuating family-centered elderly care, informal care is still viewed as a family or moral issue rather than a social and policy issue in South Korea. Using newly available micro data from the Korean Longitudinal Study of Aging, this study investigates the effect of informal caregiving on labor market outcomes in South Korea. By doing so, this study provides evidence to inform elderly long-term care policy in South Korea, and also fills a gap in the international literature by providing results from an Asian country. Empirical analyses address various methodological issues by investigating gender differences, by examining both extensive and intensive labor market adjustments with two definitions of labor force participation, by employing different functional forms of care intensity, and by accounting for the potential endogeneity of informal care as well as intergenerational co-residence. Robust findings suggest negative effects of informal caregiving on labor market outcomes among women, but not among men. Compared with otherwise similar non-caregivers, female intensive caregivers who provide at least more than 10 hours of care per week are at an increased risk of being out of the labor force by 15.2 percentage points. When examining the probability of employment in the formal sector only, the effect magnitude is smaller. Among employed women, more intensive caregivers receive lower hourly wages by 1.65K Korean Won than otherwise similar non-caregivers. Informal care is already an important economic issue in South Korea even though aging is still at an early stage.
Topic:
Demographics, Health, and Markets
Political Geography:
Israel, Asia, and South Korea

67. The sting of climate change

Author:
Sarah Potter
Publication Date:
11-2008
Content Type:
Policy Brief
Institution:
Lowy Institute for International Policy
Abstract:
Global climate change will intensify the already significant malaria and dengue problems in maritime Southeast Asia and the Pacific Islands. Those countries with the fewest resources and poor public health infrastructure are likely to feel the impact of increasing disease the most acutely. Australia itself is a 'fringe country' to the expanding endemic zone of mosquito-borne diseases to its north. Climate change may well make more of northern Australia more vulnerable to malaria and dengue outbreaks.
Topic:
Climate Change, Environment, and Health
Political Geography:
Asia and Australia/Pacific

68. Global Panic, Local Repercussions: Exploring the Impact of Avian Influenza in Vietnam

Author:
Stacy Lockerbie
Publication Date:
09-2008
Content Type:
Working Paper
Institution:
Institute on Globalization and the Human Condition, McMaster University
Abstract:
Despite deliberately marked and guarded political and cultural boundaries, the current global state is one where epidemic is the norm and disease travels across the globe through the transnational movement of people and international trade. While developing countries or countries receiving foreign aid are at the centre of disease fatality and transmission, the rhetoric of blame serves to strengthen socio-economic divisions that divide East from West and North from South with adjectives like “modern” and “primitive,” “hygienic” and “unhygienic.” Using chicken as a metaphor, this paper draws attention to the paradoxes and misconceptions of avian influenza in Vietnam and through the exploration of local voices, comes to a better understanding of how the disease rhetoric has affected the social and cultural landscape. This research is situated in the discipline somewhere between the anthropology of infectious disease and the anthropology of food, while also incorporating themes from anthropological theory pertaining to borders, hegemonies and race. Moving beyond the epidemiological study of avian flu, I draw attention to the phenomenology or lived experience in a state of disease as residents voluntarily omit chicken, a valuable source of protein, from their diet in order to stay healthy.
Topic:
Globalization and Health
Political Geography:
Asia and Vietnam

69. The World is Still Waiting: Broken G8 promises are costing millions of lives

Publication Date:
05-2007
Content Type:
Policy Brief
Institution:
Oxfam Publishing
Abstract:
Poverty and suffering could be ended in our lifetime, and our leaders must do everything in their power to make this happen. This was the clear demand of the 40 million people in 36 countries who took part in the Global Call to Action Against Poverty in 2005. A year later, in the space of just one day, 24 million people across the world stood up against poverty as part of World Poverty Day.
Topic:
Education, Health, and Poverty
Political Geography:
Russia, United States, Japan, United Kingdom, Europe, Canada, Asia, France, Germany, and Italy

70. Interview with Thai Health Minister Mongkol Na Songkhla

Author:
Nermeen Shaikh
Publication Date:
05-2007
Content Type:
Working Paper
Institution:
Asia Society
Abstract:
Mongkol Na Songkhla is the Minister of Public Health in Thailand. He has served in the Ministry of Public Health since his appointment on October 9, 2006. Dr. Mongkol Na Songkhla spoke with Asia Society's Nermeen Shaikh during a visit to New York where he joined a press conference with President Bill Clinton and the Clinton Foundation to announce a global pooled procurement of anti-retroviral drugs.
Topic:
HIV/AIDS, Government, and Health
Political Geography:
New York, Asia, and Thailand