Health care decisions as a family matter - intra-household education externalities and the utilization of health services
The author is concerned with the role of education as a determinant of health care choices. His central premise is that utilization of health services is determined not solely by an individual's own education, but rather by a notion of effective education, which incorporates the educational attainment of other household members. The author sets out a general framework for representing intra-household education externalities, and proposes a number of specific hypotheses concerning the way in which the education of different household members affects health care choices. He tests these hypotheses on data from Mozambique, focusing on maternity services and child immunizations. The author draws five major conclusions from the analysis. First, while maternal education seems to be the education variable of primary importance for the health care choices under consideration, the education of other household members has a significant and sometimes large effect. Second, his analysis suggests that while the education of the person (non-spouse) in the household with the highest-level education is important,the level of education of additional household members does not have an impact on health care choices. Third, the data provide no evidence of a gender difference in education externalities. Fourth, the author examines the merits of two alternative representations of the education externality, but is unable to conclude unambiguously in favor of one specification over the other. Finally, although the analysis highlights the importance of both education and a number of other explanatory variables in understanding health care choices, spatial fixed effects remain highly significant.
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- Thomas, Duncan & Strauss, John & Henriques, Maria-Helena, 1990. "Child survival, height for age and household characteristics in Brazil," Journal of Development Economics, Elsevier, vol. 33(2), pages 197-234, October.
- Basu, Kaushik & Narayan, Ambar & Ravallion, Martin, 2001. "Is literacy shared within households? Theory and evidence for Bangladesh," Labour Economics, Elsevier, vol. 8(6), pages 649-665, December.
- Lavy, V & Strauss, J & Thomas, D & de Vreyer, P, 1996.
"Quality of Health Care, Survivial and Health Outcomes in Ghana,"
96-20, RAND - Reprint Series.
- 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.
- Sonalde Desai & Soumya Alva, 1998. "Maternal education and child health: Is there a strong causal relationship?," Demography, Springer, vol. 35(1), pages 71-81, February.
- Benefo, Kofi & Schultz, T Paul, 1996. "Fertility and Child Mortality in Cote d'Ivoire and Ghana," World Bank Economic Review, World Bank Group, vol. 10(1), pages 123-58, January.
- 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.
- Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc.
- Hossain, Shaikh I., 1989. "Effect of public programs on family size, child education and health," Journal of Development Economics, Elsevier, vol. 30(1), pages 145-158, January.
- Wong, Emelita L. & Popkin, Barry M. & Guilkey, David K. & Akin, John S., 1987. "Accessibility, quality of care and prenatal care use in the Philippines," Social Science & Medicine, Elsevier, vol. 24(11), pages 927-944, January.
- Gibson, John, 2001. "Literacy and Intrahousehold Externalities," World Development, Elsevier, vol. 29(1), pages 155-166, January.
- Foster, Andrew D & Rosenzweig, Mark R, 1996.
"Technical Change and Human-Capital Returns and Investments: Evidence from the Green Revolution,"
American Economic Review,
American Economic Association, vol. 86(4), pages 931-53, September.
- Mark Rosenzweig & Andrew D. Foster, . "Technical Change and Human Capital Returns and Investments: Evidence from the Green Revolution," Home Pages _065, University of Pennsylvania.
- Panis, Constantijn W. A. & Lillard, Lee A., 1994.
"Health inputs and child mortality: Malaysia,"
Journal of Health Economics,
Elsevier, vol. 13(4), pages 455-489.
- Gertler, Paul & Rahman, Omar & Feifer, Chris & Ashley, Deanna, 1993. "Determinants of pregnancy outcomes and targeting of maternal health services in Jamaica," Social Science & Medicine, Elsevier, vol. 37(2), pages 199-211, July.
- Basu, Kaushik & Foster, James E., 1998.
"On measuring literacy,"
Policy Research Working Paper Series
1997, The World Bank.
- Guilkey, David K. & Riphahn, Regina T., 1998. "The determinants of child mortality in the Philippines: estimation of a structural model," Journal of Development Economics, Elsevier, vol. 56(2), pages 281-305, August.
- T. Paul Schultz, 1999.
"Health and Schooling Investments in Africa,"
Journal of Economic Perspectives,
American Economic Association, vol. 13(3), pages 67-88, Summer.
- Behrman, Jere R. & Deolalikar, Anil B., 1988. "Health and nutrition," Handbook of Development Economics, in: Hollis Chenery & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 1, chapter 14, pages 631-711 Elsevier.
- Strauss, J. & Thomas, D., 1995. "Empirical Modeling of Household and Family Decisions," Papers 95-12, RAND - Reprint Series.
- Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, August.
- Wolfe, Barbara L. & Behrman, Jere R., 1982. "Determinants of child mortality, health, and nutrition in a developing country," Journal of Development Economics, Elsevier, vol. 11(2), pages 163-193, October.
- Strauss, J. & Thomas, D., 1995.
"Health, Nutrition and Economic development,"
95-23, RAND - Labor and Population Program.
- Akin, John S, et al, 1986. "The Demand for Primary Health Care Services in the Bicol Region of the Philippines," Economic Development and Cultural Change, University of Chicago Press, vol. 34(4), pages 755-82, July.
- Wolfe, Barbara L & Behrman, Jere R, 1984. "Determinants of Women's Health Status and Health-Care Utilization in a Developing Country: A Latent Variable Approach," The Review of Economics and Statistics, MIT Press, vol. 66(4), pages 696-703, November.
- Schwartz, J Brad & Akin, John S & Popkin, Barry M, 1988. "Price and Income Elasticities of Demand for Modern Health Care: The Case of Infant Delivery in the Philippines," World Bank Economic Review, World Bank Group, vol. 2(1), pages 49-76, January.
- Kaushik Basu & James E.Foster & S. Subramanian, 2000. "Isolated and Proximate Illiteracy And Why these Concepts Matter in Measuring Literacy and Designing Education Programmes," Vanderbilt University Department of Economics Working Papers 0002, Vanderbilt University Department of Economics.
- Basu, Kaushik & Narayan, Ambar & Ravallion, Martin, 1999. "Is knowledge shared within households?," Policy Research Working Paper Series 2261, The World Bank.
- Strauss, John & Thomas, Duncan, 1995. "Human resources: Empirical modeling of household and family decisions," Handbook of Development Economics, in: Hollis Chenery & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 3, chapter 34, pages 1883-2023 Elsevier.
- Barrera, Albino, 1990. "The role of maternal schooling and its interaction with public health programs in child health production," Journal of Development Economics, Elsevier, vol. 32(1), pages 69-91, January.
- Behrman, Jere R. & Wolfe, Barbara L., 1987. "How does mother's schooling affect family health, nutrition, medical care usage, and household sanitation?," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 185-204.
- Bicego, George T. & Ties Boerma, J., 1993. "Maternal education and child survival: A comparative study of survey data from 17 countries," Social Science & Medicine, Elsevier, vol. 36(9), pages 1207-1227, May.
- Ryan, Gery W., 1998. "What do sequential behavioral patterns suggest about the medical decision-making process?: Modeling home case management of acute illnesses in a rural Cameroonian village," Social Science & Medicine, Elsevier, vol. 46(2), pages 209-225, January.
- Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
- T. Paul Schultz, 1999. "Health and Schooling Investments in Africa," Working Papers 801, Economic Growth Center, Yale University.
- Paul Glewwe, 1999. "Why Does Mother's Schooling Raise Child Health in Developing Countries? Evidence from Morocco," Journal of Human Resources, University of Wisconsin Press, vol. 34(1), pages 124-159.
- Anastasia Gage & A. Sommerfelt & Andrea Piani, 1997. "Household structure and childhood immunization in Niger and Nigeria," Demography, Springer, vol. 34(2), pages 295-309, May.
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