Children, Inequality and the Intra-household Allocation of Healthcare Resources in Three Transition Countries

This paper focuses on how the distribution of household health resources can be influenced by bargaining within the household with a particular focus on gender biases across children for four countries; Armenia, Azerbaijan, Kyrgyzstan and Tajikistan. The framework utilised is owed to McElroy and Horney (1981). Following McElroy and Horney the value function for our bargainers is derived and it is on this that our empirical specification is based. Our measure of healthcare resources at an individual level is $USD spent on preventative care and our analysis therefore has a multi-level structure with individuals clustered within households. The Hausman Taylor estimator is utilised to allow for certain explanatory variables to be endogenous with the household effects. The Asian Development Bank (ADB) through a household survey compiled the dataset used in this study in early 2007. The results reject the unitary model for all four countries, with the education gap between spouses being the most influential characteristic with respect to bargaining. The results also indicate a pro-boy bias with respect to resource allocation across children for all countries. In addition, a female offset of some of this pro-boy bias is found when a female is the household leader (excluding Kyrgyzstan). For these three countries pro-boy bias is worse in male lead households. Given that previous research suggests that a blanket increase in healthcare access may simply aid the advantaged group � in this case boys- it is our recommendation that schemes to offset this bias should provide free access to girls only, with particular attention being paid to the 4-16 female age group, where these biases are argued to be irrational and are certainly larger in magnitude as illustrated by our quantitative results.