Determinants of Health Care Decisions: Children's Health in Mali

医疗保健决策的决定因素：马里儿童的健康

• 批准号: ES/K01207X/1
• 负责人: Mark Dean
• 金额: $ 12.75万
• 依托单位: Innovations for Poverty Action
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2013
• 资助国家: 英国
• 起止时间: 2013 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FK01207X%2F1
• 关键词: Determinants; Health; Care; Decisions; Children

The delivery and funding of primary healthcare in developing countries, particularly for children, is the subject of sustained debate -- not least in light of child morbidity and mortality rates that continue to fall short of the Millennium Development Goals. Following evidence of increased utilization and improved health outcomes under free care, many African countries have recently fully or partly abolished user fees. Arguably, however, free care can lead to overuse and moral hazard, for example by reducing prevention efforts. There is a tension between subsidizing care to reduce barriers to access arising from market failures, and maintaining the role of prices in efficiently directing resources to those who value them most.The goal of this project is to study the effect of providing free healthcare and free health worker visits on three important decisions parents make for the health of their children: the time they wait before seeking care in an acute spell of illness, use of preventive care, and the use of formal vs. informal sector care. The combination of health worker visits with free care has the potential to increase access to care for poor families while reducing the inefficiencies associated with abolishing user fees - such as the overuse of primary care and the underuse of preventative care: health workers may provide better information to parents about the need for care, and also 'nudge' them towards better healthcare practices. We study the interaction of these policies with three key characteristics of households which may lead parents to underuse care for their children if they face the market price: financial constraints and an inability to borrow or save; insufficient information about health and healthcare; and the possibility that parents' spending priorities differ from those of a policymaker. The channels through which policies affect decisions are important in understanding the efficiency gains and losses from abolishing user fees and the potential of health workers to counteract some of these losses.The data for this project comes from a randomized controlled trial (RCT) conducted in a peri-urban area of Bamako, Mali. The RCT consists of two interventions; free primary care for children and free health worker visits. For each child we collect uniquely detailed data on socio-economic background as well as a complete health history over 10 weeks - detailing on a daily basis all symptoms that a child exhibits, and all healthcare sought by the mother. This data allows us to study in detail how free healthcare and health worker visits affect the healthcare behaviors of parents, and how the effects depend on the household's financial resources, its knowledge and beliefs about health issues, and its preference. The health worker intervention is in this context particularly interesting because it may on the one hand be able to address inefficiencies more directly and therefore be a viable alternative to free care, and on the other it may provide a means to counteract some of the inefficiencies of free care.Our study focuses on the effect of policy on the healthcare choices that families make, as well as on healthcare outcomes. Because of this, it will help us to understand the constraints that prevent different types of families from obtaining high quality care. This in turn will allow us to develop a model which we can used to estimate the impact of policies other than those we test directly - for example a partial abolition of fees, or means tested subsidies. In this way, our approach will make a significant contribution to the evidence-based design of healthcare policy

发展中国家，特别是对于儿童的主要医疗保健的提供和资金是持续辩论的主题 - 尤其是鉴于儿童的发病率和死亡率持续不超过千年发展目标。在自由护理下利用率增加和改善健康状况的证据之后，许多非洲国家最近已完全或部分废除了用户费用。但是，可以说，自由护理可能会导致过度使用和道德危害，例如减少预防工作。 There is a tension between subsidizing care to reduce barriers to access arising from market failures, and maintaining the role of prices in efficiently directing resources to those who value them most.The goal of this project is to study the effect of providing free healthcare and free health worker visits on three important decisions parents make for the health of their children: the time they wait before seeking care in an acute spell of illness, use of preventive care, and the use of formal vs. informal sector care.卫生工作者探访与自由护理的结合有可能增加对贫困家庭的护理机会，同时减少与废除用户费用相关的效率低下（例如过度使用初级保健和预防性护理的不足：卫生工作者可能会为父母提供有关护理需求的更好信息，并''Nudge'对他们的医疗保健实践更好。我们研究了这些政策与家庭的三个关键特征的互动，如果他们面对市场价格，可能会导致父母对孩子的照顾不足：财务限制和无力借用或储蓄；关于健康和医疗保健的信息不足；父母的支出优先级与决策者的支出不同。政策影响决策的渠道对于理解废除用户费用的效率增长和损失很重要，以及卫生工作者抵消其中一些损失的潜力。该项目的数据来自在马里巴里（Mali）巴马科（Bamako）郊区的一项随机对照试验（RCT）。 RCT包括两种干预措施；免费的儿童初级保健和免费卫生工作者就诊。对于每个孩子，我们收集有关社会经济背景以及10周的完整健康病史的独特详细数据 - 每天详细介绍儿童表现出的所有症状以及母亲所寻求的所有医疗保健。这些数据使我们能够详细研究自由医疗保健和卫生工作者的访问如何影响父母的医疗保健行为，以及效果如何依赖于家庭的财务资源，其对健康问题的知识和信念及其偏好。在这种情况下，卫生工作者的干预特别有趣，因为它一方面可能能够更直接地解决效率低下，因此成为自由护理的可行替代方案，而另一方面，它可能会提供一种能够抵消一些自由护理效率低下的方法。我们的研究侧重于政策对家庭的医疗选择的影响以及对医疗服务的医疗选择的影响。因此，它将帮助我们了解防止不同类型家庭获得高质量护理的约束。反过来，这将使我们能够开发一个模型，我们可以用来估算除直接测试的政策以外的其他政策的影响 - 例如部分废除费用或表示经过测试的补贴。这样，我们的方法将为基于证据的医疗保健政策做出重大贡献

项目成果

Subsidies, Information, and the Timing of Children's Health Care in Mali

马里儿童医疗保健的补贴、信息和时间安排

• DOI: 10.2139/ssrn.2851399
• 发表时间: 2016
• 期刊: SSRN Electronic Journal
• 作者: Sautmann A

The Effects of Community Health Worker Visits and Primary Care Subsidies on Health Behavior and Health Outcomes for Children in Urban Mali

社区卫生工作者就诊和初级保健补贴对马里城市儿童健康行为和健康结果的影响

• DOI: 10.1093/wber/lhad006
• 发表时间: 2023
• 期刊: The World Bank Economic Review
• 作者: Dean M

Credit Constraints and the Measurement of Time Preferences

信用约束和时间偏好的测量

• DOI: 10.2139/ssrn.2423951
• 发表时间: 2014
• 期刊: SSRN Electronic Journal
• 作者: Dean M