Economic analysis (quantitative public health, demography)

Work group:

Qays Bousmah, Sylvie Boyer, El hadji Ba, Richard Lalou, Cheikh Sokhna, Carole Treibich, Bruno Ventelou, Marc Willinger


Micro-econometrics of health and the family

Objectives and general problem :

This component interacts with component 1 dedicated to public health policies. This will involve measuring, at the microeconomic level, a series of direct and indirect effects of the extension of health insurance in Senegal. Evaluating such effects a key element in assessing the feasibility of implementing universal health coverage (UHC) in the Sahel region.

We propose to study the impact of the policy of free access for certain categories of the population, the establishment of mutual funds and the family solidarity grant program :

  • financial risks linked to health: the effect of health coverage on the protection of households against catastrophic health expenditure is varied. Membership of health insurance can both reduce this risk (Saksena et al., 2011) and increase it (Wagstaff & Lindelow, 2008);

  • inequalities in access to health services: membership of a mutual health organization or free health care can have the effect of reducing these inequalities (McKinnon et al., 2015);

  • fertility: in Senegal, it has been shown that households adjust their reproductive behavior in a context of low probability of infant survival (Bousmah, 2017). Our intuition is that the extension of health insurance, when it reduces infant morbidity and mortality, may have the effect of reducing reproduction and accelerating demographic transition;

  • schooling and child labor. It has been shown that households not affiliated with mutuals insurance policies resort to child labor following a health shock of one of the parents, while this was not the case for affiliated households (Woode et al. ., 2017). Membership of these policies also plays a mediating role in the effect of a parental health shock following the dropout of children (Woode, 2017).

Methodology and data:

The part of the project on the impact of membership in a community health mutual will be based on two types of data: (1) the representative national survey EDS-MICS 2010-11 (subsequent surveys do not collect information on affiliation to health insurance, but comparative studies could be carried out on Burkina Faso with the 2010 DHS survey and Mali with the 2012-13 DHS survey), and (2) a cross-sectional survey conducted in the community of Niakhar (Fatick). The implementation of this latest study is conditioned by the results of an ongoing survey (as part of a study on HBV), which will determine the rate of membership in a mutual health insurance scheme among the inhabitants of the community of Niakhar. The planned survey will be conducted among the general population, if the membership rate for a mutual insurance company is sufficiently high; and where appropriate, with affiliates and a control group if membership rates are too low. The methodology will consist of considering selection bias by a propensity score matching method, then relying on regression models to determine the role of mutual health insurance affiliation on, for exemple, the effect of a parental health shock on child labor.

The measurement of the impact of free healthcare will be based on the Senegalese DHS surveys and the Niakhar community demographic surveillance system. We will take for example the case of the policy of exemption from payment for deliveries in health centers, introduced in January 2005 in the five poorest regions (Kolda, Ziguinchor, Tambacounda, Matam and Fatick), then in January 2006 in the rest of the country. Interrupted time series models will allow us to identify whether the intervention impacted the proportion

births in health centers and neonatal mortality. Finally, the double-difference method will allow us to measure the impact of this intervention, for example on fertility differentials. Finally, the effect of the allocation of family grants will be measured as part of the cross-sectional survey that we plan to conduct in the community of Niakhar.

Deux enquêteurs à Niakhar, photo prise par Marwan Al Qays Bousmah