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31. Free Distribution Or Cost-Sharing? Evidence From A Randomized Malaria Prevention Experiment

Author:
Jessica Cohen
Publication Date:
12-2007
Content Type:
Working Paper
Institution:
The Brookings Institution
Abstract:
It is widely believed that cost-sharing—charging a subsidized, positive price—for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument in the context of a field experiment in Kenya, in which we randomized the price at which pregnant women could buy long lasting anti-malarial insecticide-treated nets (ITNs) at prenatal clinics. We find no evidence that cost-sharing reduces wastage on those that will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that cost-sharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the prenatal clients in the control group in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by 75 percent when the price of ITNs increases from 0 to $0.75, the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of ITN prices on infant mortality that incorporates both private and social returns to ITN usage. Overall, given the large positive externality associated with widespread usage of insecticide-treated nets, our results suggest that free distribution to pregnant women is both more effective and more cost-effective than cost-sharing.
Topic:
Development, Globalization, Health, and World Health Organization
Political Geography:
Kenya

32. The 1971 Smallpox Epidemic in Aralsk, Kazakhstan, and the Soviet Biological Warfare Program

Author:
Jonathan B. Tucker and Raymond A. Zilinskas
Publication Date:
10-2002
Content Type:
Working Paper
Institution:
James Martin Center for Nonproliferation Studies
Abstract:
The heart of this occasional paper is a translation of an official Soviet-era document titled “Report on Measures Taken to Contain and Eradicate the Smallpox Outbreak Locale in the City of Aralsk, September/October 1971.” This previously secret report describes and analyzes an outbreak of smallpox that occurred in autumn 1971 in Aralsk, a small city on the shore of the Aral Sea in what was then the Kazakhstan Soviet Socialist Republic. Ten persons became infected with smallpox, and three died, before the outbreak was successfully contained by means of quarantine, mass vaccination in Aralsk, and other public health measures. A contagious disease that killed about a third of its victims, smallpox was characterized by high fever, prostration, and a painful pustular rash on the face and body that left survivors with disfiguring facial scars.
Topic:
Health, Terrorism, War, Weapons of Mass Destruction, World Health Organization, and Biosecurity
Political Geography:
Central Asia and Kazakhstan