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Healthcare Choices, Information and Health Outcomes

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  • Adhvaryu, Achyuta
  • Nyshadham, Anant

Abstract

Self-selection into healthcare options on the basis of severity likely biases estimates of the effects of healthcare choice on health outcomes. Using an instrumental variables strategy which exploits exogenous variation in the cost of formal-sector care, we show that using such care to treat acute sickness decreases the incidence of fever and malaria in young children in Tanzania. Compared to the instrumental variables estimates, ordinary least squares estimates significantly understate the effects of formal-sector healthcare use on health outcomes. Improved information and more timely treatment, rather than greater access to medicines, seem to be the primary mechanisms for this effect.

Suggested Citation

  • Adhvaryu, Achyuta & Nyshadham, Anant, 2011. "Healthcare Choices, Information and Health Outcomes," Center Discussion Papers 107257, Yale University, Economic Growth Center.
    • Handle: RePEc:ags:yaleeg:107257
    DOI: 10.22004/ag.econ.107257
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    1. Gowrisankaran, Gautam & Town, Robert J., 1999. "Estimating the quality of care in hospitals using instrumental variables," Journal of Health Economics, Elsevier, vol. 18(6), pages 747-767, December.
    2. Jessica Cohen & Pascaline Dupas, 2008. "Free Distribution or Cost-Sharing? Evidence from a Malaria Prevention Experiment," NBER Working Papers 14406, National Bureau of Economic Research, Inc.
    3. John Strauss & Duncan Thomas, 1998. "Health, Nutrition, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 36(2), pages 766-817, June.
    4. Chang, Fwu-Ranq, 1996. "Uncertainty and investment in health," Journal of Health Economics, Elsevier, vol. 15(3), pages 369-376, June.
    5. Joseph J. Doyle, 2005. "Health Insurance, Treatment and Outcomes: Using Auto Accidents as Health Shocks," The Review of Economics and Statistics, MIT Press, vol. 87(2), pages 256-270, May.
    6. Cropper, M L, 1977. "Health, Investment in Health, and Occupational Choice," Journal of Political Economy, University of Chicago Press, vol. 85(6), pages 1273-1294, December.
    7. Grossman, Michael, 2000. "The human capital model," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 7, pages 347-408, Elsevier.
    8. Achyuta R. Adhvaryu & Anant Nyshadham, 2012. "Schooling, Child Labor, and the Returns to Healthcare in Tanzania," Journal of Human Resources, University of Wisconsin Press, vol. 47(2), pages 364-396.
    9. Selden, Thomas M., 1993. "Uncertainty and health care spending by the poor: The health capital model revisited," Journal of Health Economics, Elsevier, vol. 12(1), pages 109-115, April.
    10. Duflo, Esther & Udry, Christopher R., 2003. "Intrahousehold Resource Allocation in Cote D'Ivoire: Social Norms, Separate Accounts and Consumption Choices," Center Discussion Papers 28404, Yale University, Economic Growth Center.
    11. Dow, W & Gertly, P & Schoeni, R-F & Strauss, J & Thomas, D, 1997. "Health Care Prices, Health and Labor Outcomes : Experimental Evidence," Papers 97-01, RAND - Labor and Population Program.
    12. Zhu, Minmin & Dib, Hassan H. & Zhang, Xinping & Tang, Shengchun & Liu, Liqun, 2008. "The influence of health insurance towards accessing essential medicines: The experience from Shenzhen labor health insurance," Health Policy, Elsevier, vol. 88(2-3), pages 371-380, December.
    13. Douglas Almond & Joseph J. Doyle & Amanda E. Kowalski & Heidi Williams, 2010. "Estimating Marginal Returns to Medical Care: Evidence from At-risk Newborns," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(2), pages 591-634.
    14. Michael Kremer & Edward Miguel, 2007. "The Illusion of Sustainability," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(3), pages 1007-1065.
    15. David M. Cutler & Robert S. Huckman & Mary Beth Landrum, 2004. "The Role of Information in Medical Markets: An Analysis of Publicly Reported Outcomes in Cardiac Surgery," American Economic Review, American Economic Association, vol. 94(2), pages 342-346, May.
    16. Julie S. Downs & George Loewenstein & Jessica Wisdom, 2009. "Strategies for Promoting Healthier Food Choices," American Economic Review, American Economic Association, vol. 99(2), pages 159-164, May.
    17. Paul Gertler, 2004. "Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA's Control Randomized Experiment," American Economic Review, American Economic Association, vol. 94(2), pages 336-341, May.
    18. Germano Mwabu & Martha Ainsworth & Andrew Nyamete, 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 28(4), pages 838-862.
    19. Joseph J. Doyle Jr., 2005. "Health Insurance, Treatment and Outcomes: Using Auto Accidents as Health Shocks," NBER Working Papers 11099, National Bureau of Economic Research, Inc.
    20. Chern, Wen S & Loehman, Edna T & Yen, Steven T, 1995. "Information, Health Risk Beliefs, and the Demand for Fats and Oils," The Review of Economics and Statistics, MIT Press, vol. 77(3), pages 555-564, August.
    21. Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987. "Are user fees regressive? : The welfare implications of health care financing proposals in Peru," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 67-88.
    22. Gustavo J. Bobonis & Edward Miguel & Charu Puri-Sharma, 2006. "Anemia and School Participation," Journal of Human Resources, University of Wisconsin Press, vol. 41(4).
    23. Pascaline Dupas, 2011. "Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 1-34, January.
    24. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, January.
    25. Bjorklund, Anders & Moffitt, Robert, 1987. "The Estimation of Wage Gains and Welfare Gains in Self-selection," The Review of Economics and Statistics, MIT Press, vol. 69(1), pages 42-49, February.
    26. Jessica Cohen & Pascaline Dupas, 2010. "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 1-45.
    27. Buchmueller, Thomas C. & Jacobson, Mireille & Wold, Cheryl, 2006. "How far to the hospital?: The effect of hospital closures on access to care," Journal of Health Economics, Elsevier, vol. 25(4), pages 740-761, July.
    28. Lavy, Victor & Strauss, John & Thomas, Duncan & de Vreyer, Philippe, 1996. "Quality of health care, survival and health outcomes in Ghana," Journal of Health Economics, Elsevier, vol. 15(3), pages 333-357, June.
    29. Harsha Thirumurthy & Joshua Graff Zivin & Markus Goldstein, 2008. "The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya," Journal of Human Resources, University of Wisconsin Press, vol. 43(3), pages 511-552.
    30. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    31. John Geweke & Gautam Gowrisankaran & Robert J. Town, 2003. "Bayesian Inference for Hospital Quality in a Selection Model," Econometrica, Econometric Society, vol. 71(4), pages 1215-1238, July.
    32. Card, David, 2001. "Estimating the Return to Schooling: Progress on Some Persistent Econometric Problems," Econometrica, Econometric Society, vol. 69(5), pages 1127-1160, September.
    33. A. J. Culyer & J. P. Newhouse (ed.), 2000. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, edition 1, volume 1, number 1.
    34. Leonard, Kenneth L, 2007. "Learning in Health Care: Evidence of Learning about Clinician Quality in Tanzania," Economic Development and Cultural Change, University of Chicago Press, vol. 55(3), pages 531-555, April.
    35. Adhvaryu, Achyuta & Nyshadham, Anant, 2011. "Labor Supply, Schooling and the Returns to Healthcare in Tanzania," Center Discussion Papers 107260, Yale University, Economic Growth Center.
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    Cited by:

    1. Achyuta Adhvaryu & Anant Nyshadham, 2011. "Labor Supply, Schooling and the Returns to Healthcare in Tanzania," Working Papers 995, Economic Growth Center, Yale University.
    2. Achyuta Adhvaryu & Anant Nyshadham, 2011. "Labor Complementarities and Health in the Agricultural Household," Working Papers 996, Economic Growth Center, Yale University.
    3. Achyuta R. Adhvaryu & Anant Nyshadham, 2012. "Schooling, Child Labor, and the Returns to Healthcare in Tanzania," Journal of Human Resources, University of Wisconsin Press, vol. 47(2), pages 364-396.

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    Keywords

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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O10 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - General
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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