Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach

Accessibility and satisfaction related to healthcare services are conceived as multidimensional concepts. These concepts can be studied using objective and subjective measures. In this study, we created two indices: a composite healthcare accessibility index (CHCA) and a composite healthcare satisfaction index (CHCS). To calculate the CHCA index we used three indicators based on three components of multidimensional healthcare accessibility: availability, acceptability and accessibility. In the indicator based on the component of accessibility, we included an innovative perceived time-decay parameter. The three indicators of the CHCA index were weighted through the application of a principal components analysis. To calculate the CHCS index, we used three indicators: the waiting time after the patient arrives at the healthcare service, the quality of the healthcare, and the healthcare service supply. These three indicators making up the CHCA index were weighted by applying an analytical hierarchy process. Three kinds of regressions were subsequently applied in order to explain the CHCA and CHCS indices: namely the Linear Least Squares, Ordinal Logistic, and Random Forests regressions. In these regressions, we used different independent social and health-related variables. These variables represented the predisposing, enabling, and need factors of people´s behaviors related to healthcare. All the calculations were applied to a study area: the city of Quito, Ecuador. Results showed that there are health-related inequalities in regard to healthcare accessibility and healthcare satisfaction in our study area. We also identified specific social factors that explained the indices developed. The present work is a mixed-methods approach to evaluate multidimensional healthcare accessibility and healthcare satisfaction, incorporating a pluralistic perspective, as well as a multidisciplinary framework. The results obtained can also be considered as tools for healthcare and urban planners, for more integrative social analyses that can improve the quality of life in urban residents.     

Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001–2013: A Distributional Analysis Using Household Asset Indicators

Understanding the distribution of socioeconomic status (SES) and its temporal dynamics within a population is critical to ensure that policies and interventions adequately and equitably contribute to the well-being and life chances of all individuals. This study assesses the dynamics of SES in a typical rural South African setting over the period 2001–2013 using data on household assets from the Agincourt Health and Demographic Surveillance System. Three SES indices, an absolute index, principal component analysis index and multiple correspondence analysis index, are constructed from the household asset indicators. Relative distribution methods are then applied to the indices to assess changes over time in the distribution of SES with special focus on location and shape shifts. Results show that the proportion of households that own assets associated with greater modern wealth has substantially increased over time. In addition, relative distributions in all three indices show that the median SES index value has shifted up and the distribution has become less polarized and is converging towards the middle. However, the convergence is larger from the upper tail than from the lower tail, which suggests that the improvement in SES has been slower for poorer households. The results also show persistent ethnic differences in SES with households of former Mozambican refugees being at a disadvantage. From a methodological perspective, the study findings demonstrate the comparability of the easy-to-compute absolute index to other SES indices constructed using more advanced statistical techniques in assessing household SES.     

Students Mobility: Assessing the Determinants of Attractiveness Across Competing Territorial Areas

A central question for education authorities has become “which factors make a territory attractive for tertiary students?” Tertiary education is recognised as one of the most important assets for the development of a territory, thus students’ mobility becomes a brain drain issue whenever there are prevalent areas that attract students from other territories. In this paper, we try to identify the most important factors that could affect student mobility in Italy. In doing that we analyse students’ flows across competing territorial areas which supply tertiary education programs. We will consider a wide range of determinants related to the socio-economic characteristics of the areas as well as resources of the universities in the territories in terms of variety and quantity of the degree programs there available, financial endowments provided by Central Government, and services available to students. The Bradley–Terry modelling approach based on pair comparisons has been adopted to define the attractiveness of competing territories and assess how much the detected divergences can be attributed to factors directly related to the considered characteristics of the universities in the territory and how much is ascribable to inherent characteristics of the areas where the universities are located such as the labour market conditions. Furthermore, the adopted approach allows us to consider uncertainty in defining territorial attractiveness and making comparisons. In this way, we would like to provide some evidences to assess if the rules currently used by the Central Government to finance public universities on the basis of their capabilities to attract students really reward the efforts made by the university system in the area to improve their standard of quality or, on the contrary, reward the territorial features.     

Exploring the Eligibility Criteria of the Child Support Grant and its Impact on Poverty

One of the most important policy objectives in the post-apartheid South African economy is to reduce poverty. Although economic growth and job creation are the preferred sources of alleviating poverty and inequality, social grant spending has contributed significantly to reduce poverty (Van der Berg et al. in Poverty trends since the transition: what we know. Stellenbosch Economic Working Papers: 19/09. Stellenbosch: Stellenbosch University, 2009). Recently proposals were tabled by the Department of Social Development of South Africa (Fin24 in R3.3bn plan to extend child support grant to 21. http://www.fin24.com/Economy/R33bn-child-care-grant-extension-to-21-on-cards-20150316. Accessed August 7, 2015, 2015) to extend the age eligibility of the child support grant (CSG) to 21 years (at the time of writing children aged up to 18 years are eligible). This sparked an interest to investigate the impact on poverty of changes to the eligibility criteria of CSG, as well as its fiscal implications. Using person and household data from the 2010/2011 Income and Expenditure Survey, various simulations are performed to assess the impact on poverty rates and changes to social spending, given the following changes: (1) if all age-eligible children applied; (2) if all beneficiaries received the grant amount for the full 12-month duration; (3) if the age eligibility criterion is extended; and (4) if the monthly child grant income amount is revised upwards. We also examine how changes in the eligibility criteria affect the income distribution.     

Health responses to a wealth shock: evidence from a Swedish tax reform

This paper makes two contributions to the literature on the effects of wealth on health. First, it deals with reverse causality and omitted variable bias by exploiting exogenous variation in inherited wealth generated by the repeal of the Swedish inheritance tax. Second, it analyzes responses in health outcomes through the use of administrative registers. The results show that increased wealth has limited short to medium run impacts on objective adult health. This is in line with what has previously been reported in the literature.     

Do anti-bullying laws work? New evidence on school safety and youth violence

This study is the first to comprehensively examine the effect of state anti-bullying laws (ABLs) on school safety and youth violence. Using existing data from the Youth Risk Behavior Surveys and the Uniform Crime Reports, and newly-collected data on school shootings, we find little evidence that the typical state ABL is effective in improving school safety and student well-being. However, this null finding masks substantial policy heterogeneity. State mandates that require school districts to implement strong, comprehensive anti-bullying policies are associated with a 7 to 13 % reduction in school violence and an 8 to 12 % reduction in bullying. In addition, our results show that strong anti-bullying policy mandates are associated with a reduction in minor teen school shooting deaths and violent crime arrests, suggesting potentially important spillover effects.     

<Emphasis Type="Italic">Knot yet</Emphasis>: minimum marriage age law,marriage delay,and earnings

Despite the historical highs for age at first marriage, little is known about the causal relationship between marriage delay and wages, and more importantly, the mechanisms driving such relationship. We attempt to fill the void. Building on an identification strategy proposed in Dahl (Demography 47:689–718, 2010), we first establish the causal wage effects of marriage delay. We then propose ways to distinguish among competing theories and hypotheses, as well as the channels through which marriage delay affects wages. Specifically, we take advantage of their different implications for causal relationship, across gender and sub-populations. We reach two conclusions. First, we find a positive causal impact of marriage delay on wages, with a larger effect for women. Comparison of IV and OLS estimates suggests that the observed relationship between marriage delay and wages is attributed to both selection in late marriages and true causal effects. Second, we find strong evidence that the positive, causal effects are almost exclusively through increased education for both men and women.     

Stymied ambition: does a lack of economic freedom lead to migration?

We investigate the relationship between economic freedom and international migration for the 1980–2010 period using a dataset on migration from 91 emerging countries to the 20 most attractive OECD destination countries. We find that more economic freedom at home discourages high-skilled migration, but not low-skilled migration. The negative association between economic freedom and high-skilled emigration also holds when we estimate (dynamic) panel models that allow for endogeneity in the economic freedom-migration nexus. In sum, our findings suggest that high-skilled migration is especially responsive to the economic incentives resulting from economic freedom.     

Ageing-driven pension reforms

This paper stems from the observation that there are two worldwide trends, pension reform and population ageing, and asks whether the two may be related. Exploring the cases of pension reform in different countries, we find that, although they are very different, the cases share a common characteristic: they shift risks away from workers towards those who are retired. Furthermore, population ageing, by increasing the weight of the elderly relative to working generations, raises the price of intergenerational risk sharing. Combining these findings, we argue and show formally that pension reform can be seen as a welfare-best response to population ageing.     

Is education a risk factor or social vaccine against HIV/AIDS in Sub-Saharan Africa? The effect of schooling across public health periods

Early in the 30-year HIV/AIDS pandemic in Sub-Saharan Africa, epidemiological studies identified formal education attainment as a risk factor: educated Sub-Saharan Africans had a higher risk of contracting HIV/AIDS than their less educated peers. Later demographic research reported that by the mid-1990s the education effect had reversed, and education began to function as a social vaccine. Recent counter-evidence finds a curvilinear pattern, with the association between educational attainment and HIV/AIDS infection changing from positive to negative across the education gradient. To reconcile these inconsistent conclusions, a hypothesis is developed and tested that education at early stages functioned as a risk factor and later functioned (and continues to function) as a social vaccine. We reason that this shift in the direction of the education effect was concurrent with changes in the public health environment in SSA that early on heightened material benefits from educational attainment but later heightened cognitive benefits from schooling. Using the 2003/2004 Demographic Health Surveys from four Sub-Saharan African countries (Cameroon, Ghana, Kenya and Tanzania), we tested this hypothesis (differential effects of schooling) using non-linear regression analysis (probit), identifying the different public health periods and controlling for confounding factors. The results support the hypothesis that the education effect shifted historically in the HIV/AIDS pandemic in SSA as we hypothesized.