Working Papers
Measuring Medical and Cost Uncertainty in Health Care Seeking: Instrument Design and Validation (with Andreas Landmann and Lisa Rogge) - BGPE Discussion Paper No. 236
Uncertainty about medical outcomes as well as about costs to seek care might play an important role in the health care decision-making process, potentially deterring sensible health care choices. There is little theoretical and no rigorous empirical evidence on this relationship, though, also owing to the lack of established tools to measure uncertainties around medical benefits and costs of health care seeking. In this paper, we develop such a measurement tool, field a first version of it in a low-income population in Pakistan, and present the initial evidence from this pilot data collection. We conduct a qualitative and quantitative validation process and identify potential for improvement in future applications. Nevertheless, the data collected through the tool appears meaningful and the analysis shows that on top of many biases, both medical as well as cost uncertainty is present to a substantial degree in our target population. Our empirical results also suggest that uncertainty in both dimensions deters health investments.
Selected Work in Progress
Medical and Cost Uncertainty in Health Care Seeking (with Andreas Landmann and Lisa Rogge) - preregistered in AEA registry
Abstract: Health care decisions are sometimes a matter of life and death, but also their financial consequences can be disastrous for many households around the world. While it is easy to imagine how the fear of making an expensive mistake may deter particularly poor households from making otherwise sensible health care choices, there is almost no scientific evidence on the importance and joint role of medical and cost uncertainty. In this paper, we provide theoretical insights based on simulation exercises, introduce a novel measurement instrument for medical and cost uncertainty related to health investment choices, present data collected using this instrument from low-income households in Pakistan, and test the theoretical predictions using this data. As our own pre-studies indicated potentially large dividends to providing accurate information, we further included within-survey information interventions targeted at changing medical or cost uncertainty separately or jointly. With this survey experiment, we test in two intervention stages whether: i) the interventions reduce biases and uncertainties; ii) the interventions change the hypothetical health seeking decision; and iii) the joint intervention induces larger changes. Our preliminary analysis reveals that both medical as well as cost uncertainty in health care decisions exists to a substantial degree. The empirical results regarding the influence of beliefs are largely in line with theoretical predictions and suggest that uncertainty in the financial dimension deters health investments.
Health Insurance Preferences for Outpatient Care: A Discrete Choice Experiment in Pakistan (with Henrik Berberich and Lisa Rogge) - (submitted, working paper available upon request)
Abstract: State-funded health insurance schemes are increasingly implemented across low- and middle-income countries, but utilization and acceptance often remain lower than desired for Universal Health Coverage. Including features that address the beneficiary population’s preferences could improve this. We conducted a Discrete Choice Experiment to elicit preferences for a new public outpatient health insurance for low-income households in Pakistan at scheme design stage. We included five attributes that reflected the dimensions of real policy trade-offs during scheme design: health care providers, services, health conditions, coverage amount and premium. The main effects reveal relevance of all attributes and strong population preferences for including higher-level health care providers as well as telemedicine and for covering chronic disease needs. We do not detect substantial heterogeneity in preferences across socio-demographic strata, respondent and household health status, but some regarding gender and location. This indicates that overall, preferences are rather homogenous across groups, but preferences of females and respondents from more remote areas differ. We further see suggestive evidence that in a setting with low insurance literacy, only some DCE choices were made to maximise benefits along known, pre-existing health complaints and risk-factors.
Published work
Un/met: A mixed-methods study on primary healthcare needs of the poorest population in Khyber-Pakhtunkhwa province, Pakistan (with Maira Shaukat, Lisa Rogge, Fatima Khalid, Safat Ullah, Fayaz Ahmad, Zeeshan Kibria, Andreas Landmann, Zohaib Khan, Manuela De Allegri) - International Journal for Equity in Health (2024)
Reports
Needs Assessment for Scientific Implementation Research on OPD Services in the Social Health Protection Initiative in Khyber Pakhtunkhwa (KP) Province and Gilgit Baltistan (GB) Area (Baseline Report for German Development Bank) University of Erlangen-Nuremberg