RESEARCH AREAS: health economics, development economics

SELECTED PUBLICATIONS:

JOURNAL ARTICLES:

Ellegård, L. M., Kjellsson, G., Kovacs, R., Zhao, Y. (2025) Patient choice and socioeconomic disparities in the quality of healthcare: Evidence from Swedish registry data. Social Science & Medicine.

Kovacs, R., Dunaiski, M., Glizzi, M., Hortala-Vallve, R., Murtin, F. (2024) The determinants of trust: findings from large, representative samples in six OECD countries. Economica. 

Kovacs, R., Dunaiski M., Tukiainen, J. (2023) Compulsory face mask policies do not affect community mobility in Germany. The Scandinavian Journal of Economics.

Kovacs, R. , Lagarde, M. (2022) Does high workload reduce the quality of healthcare? Evidence from rural Senegal. Journal of Health Economics.

Kovacs, R. , Lagarde, M., & Cairns, J. (2022). Can patients improve the quality of care they receive? Experimental evidence from Senegal. World Development.

Kovacs, R. , Barreto, J., Nunes da Silva, E., et al. (2021). Socioeconomic inequalities in the quality of primary care under Brazil’s national pay-for-performance programme: a longitudinal study of family health teams. The Lancet Global Health. 

Kovacs, R. , Lagarde, M., & Cairns, J. (2020). Overconfident health workers provide lower quality healthcare. Journal of Economic Psychology. 

Kovacs, R., Lagarde, M., & Cairns, J. (2019). Measuring patient trust: Comparing measures from a survey and an economic experiment. Health Economics.

Kovacs, R.  (2017). The macro-level drivers of intimate partner violence: New evidence from a multilevel dataset. Global Public Health, 1–13. 

Wiseman, V., Lagarde, M., Kovacs, R., et al., (2019). Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: Key challenges and opportunities. BMJ Global Health. 

WORKING PAPERS:

Kovacs, R., Powell-Jackson, T., Hone, T., Barreto, J., Nunes da Silva, E. Paying our way to better health? The impact of public spending on health outcomes in Brazil. 

It remains unclear whether government can improve health outcomes by increasing public spending on health care. We study the effect of an increase in public spending on primary care on health care-seeking and mortality in Brazil, using an event study difference-in-differences design that covers 5,443 municipalities over 11 years. We exploit the staggered introduction of a national programme called PMAQ that increased public spending on primary care by 6% in participating municipalities. Results suggest that this substantial increase in public spending did not translate into better health on average, with coefficients precisely estimated around zero. We examine a number of potential explanations for the null finding, including corruption and the spending increase being too small. We find that the effect of public spending on health outcomes is moderated by the level of local development, as public spending only reduces mortality in wealthy municipalities. 

Kovacs, R. Does free maternity care improve access and save lives? Quasi-experimental evidence from Kenya. 

There is an ongoing debate about how to reduce maternal and neonatal mortality in low and middle-income countries (LMICs). As maternity care is not free in many LMICS, many assume that user-fees deter healthcare seeking and are therefore partially responsible for high mortality rates. This paper provides evidence on the causal effect of a national user-fee removal programme in Kenya on healthcare seeking and mortality, using a difference-in-differences design that exploits variation in treatment intensity across local communities. Results indicate a small increase in uptake of antenatal care but no average effects on facility delivery, mortality or the quality of healthcare. I examine several potential mechanisms and find heterogeneous treatment effects based on physical accessibility of care as well as community-level preferences on household decision making.

Kovacs, R. Public Vs. Private: the Quality of Ante-natal Care in Resource-poor Settings

There is a global consensus that increased uptake of antenatal care is paramount for reducing maternal and neonatal mortality in low and middle-income countries (LMICs) - which is one of the key policy goals of our time. This study provides the broadest overview to date of the quality of antenatal care in LMICs and presents data on the actions taken by healthcare providers in 21,850 consultations in 13 countries (Afghanistan, DRC, Egypt, Ghana, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania and Uganda). Results suggest that providers on average complete only 39\% of essential actions during consultations. At this alarmingly low level of quality, it is unclear to what degree increased uptake of antenatal care will have desired effects on health outcomes. Findings also speak to a longstanding debate about whether healthcare in resource-poor settings is best offered by the public or the private sector. Results suggest that even though private for-profit facilities are better equipped and staffed and close to five times as expensive, private-sector facilities do not deliver higher quality healthcare.

ONGOING PROJECTS

Gender‑based discrimination in healthcare: Using data from standardised patients in Kenya, I study the effect of patient gender on the quality of care received. I also test the effect of a training intervention on provider behaviour.

Women’s mental health: Using Swedish registry data, I examine how to design social policies to prevent post‑partum depression, centring on the role of fathers. I also investigate potential taste‑based discrimination by healthcare providers in treating immigrant women.

Mental health of healthcare providers: Using data from standardised patients in Kenya, I investigate the link between providers’ mental health and the quality of care they provide.