universal coverage with supply side reform the impact on medical expenditure risk and utilization in thailand abstract we estimate the impact on out of pocket oop medical expenditure of a major reform in thailand that greatly extended health insurance coverage to achieve universality while implementing supply side measures intended to deliver cost effective care from an increased but modest public health budget difference in differences comparison of groups to whom coverage was extended or deepened with those whose coverage did not change indicates that the reform reduced oop expenditure by 28 on average and by 42 at the 95th percentile of the conditional distribution simulations suggest that exposure to medical expenditure risk was reduced by three fifths on average generating a social welfare gain equivalent to 80 200 of the approximate deadweight loss from financing the reform estimated effects on health care access suggest that the policy managed to reduce households medical expenses while also raising their utilization of both inpatient and ambulatory care

effects of universal health insurance on health care utilization and supply side responses evidence from japan abstract we investigate the effects of a massive expansion in health insurance coverage on health care utilization and supply side responses by focusing on universal health insurance introduced in japan in 1961 there are two major findings first health care utilization measured in terms of admissions inpatient days and outpatient visits to hospitals increased significantly second we also find a supply response but the size of the supply response differs across service types while the number of beds increases effects on the number of medical institutions physicians and nurses are either negligible or inconclusive our results suggest that countries planning a large expansion in health insurance coverage would need to generate sufficient financial resources to cover the surge in health care expenditures both in the short and long run our results also indicate that any slowdown in the supply side response may constrain the ability of the health care system to meet increased demand

the marginal cost of public funds and tax reform in africa abstract in this paper we propose estimates of the marginal cost of public funds mcf in 38 african countries we develop a simple general equilibrium model that can handle taxes on five major tax classes and can be calibrated with little more than national accounts data a key feature of our model is the explicit recognition of the informal economy our base case estimate of the average mcf from marginal increases in all five tax instruments is 1 2 focusing on the lowest cost tax instruments in each country commonly the vat but not always the average mcf is 1 1 finally extending the tax base to include sections of the informal economy by removing some tax exemptions offers the potential for a low mcf source of public funds and a lowering of mcfs on other tax instruments

movers and shakers chaos makers in tourism development abstract like most of their counterparts in other social sciences tourism researchers have traditionally focused on aspects of tourism phenomena that exhibit order linearity and equilibrium while eschewing situations where disorder non linearity and disequilibrium are more apparent although constructs such as the destination life cycle model demonstrate the heuristic value of this approach it results in aspects of tourism development that are intrinsically chaotic being overlooked thus for instance the fundamental role of entrepreneurs in destination development has received scant attention largely because their behaviour is not readily understood in terms of the conventional analytical framework this paper argues that the chaos complexity perspective provides a potentially useful alternative framework for providing insights into the underlying dynamics of tourism development and a case study involving the examination of entrepreneurial activity on the gold coast in australia is used for illustrative purposes in this context chaos is presented as essentially a creative process and entrepreneurs play a primary role both as chaos makers and as initiators of adaptive responses to chaos induced by external events

consumption smoothing and the welfare consequences of social insurance in developing economies studies of risk in developing economies have focused on consumption fluctuations as a measure of the value of insurance a common view in the literature is that the welfare costs of risk and benefits of social insurance are small if income shocks do not cause large consumption fluctuations we present a simple model showing that this conclusion is incorrect if the consumption path is smooth because individuals are highly risk averse hence social safety nets could be valuable in low income economies even when consumption is not very sensitive to shocks

the role of agriculture and its prerequisites in economic development a vision for foreign development assistance abstract the aim of this paper is to establish a vision for foreign development assistance based upon the evolution of thought and empirical evidence found in the development literature the paper spotlights the agricultural led approach the empirical record shows that agricultural growth had a more pronounced impact on increases in developing country income than did growth in the nonagricultural sector the reason for the differential impact is that developing countries focusing on agricultural development experienced more broad based income growth and increases in the demand for domestically produced goods whereas the developing countries promoting rapid industrialization experienced narrow based income growth with a demand pattern oriented toward nonfood and capital intensive products a precondition for agriculture to play its proper role is the existence of a conducive environment in which private enterprise can flourish developing country governments need to assume responsibility for the creation and maintenance of essential institutions government investments are required in education infrastructure and other areas where the commercial market is not capable of delivering critical services finally governments must responsibly manage the macroeconomy pursuing sustainable pricing policies and fiscal and monetary policies that are consistent with real equilibrium exchange rates

does agricultural growth in poor countries harm agricultural exporting rich countries abstract the commonly held view that agricultural exporting developed countries would lose from agricultural growth in less developed countries lcds is shown to be based on an incomplete argument it considers only the effects on ldc agricultural supply or at best only that and the first round effects of increased farmer incomes on the demand for tradables what also needs to be considered is the effect on the demand for nontradables and hence the second round effects of increased spending by producers of nontradables when all these effects are considered the positive correlations obtained between agricultural output growth in ldcs and agricultural imports from developed countries is not surprising it is then shown that selling or giving away agricultural research and management skills to developing countries can be beneficial to developed countries including agricultural exporters by setting out to do good they may end up also doing well

censored quantile instrumental variable estimates of the price elasticity of expenditure on medical care efforts to control medical care costs depend critically on how individuals respond to prices i estimate the price elasticity of expenditure on medical care using a censored quantile instrumental variable cqiv estimator cqiv allows estimates to vary across the conditional expenditure distribution relaxes traditional censored model assumptions and addresses endogeneity with an instrumental variable my instrumental variable strategy uses a family member s injury to induce variation in an individual s own price across the conditional deciles of the expenditure distribution i find elasticities that vary from 0 76 to 1 49 which are an order of magnitude larger than previous estimates

the effect of patient cost sharing on utilization health and risk protection abstract this paper exploits a sharp reduction in patient cost sharing at age 70 in japan using a regression discontinuity design to examine its effect on utilization health and financial risk arising from out of pocket expenditures due to the national policy cost sharing is 60 80 percent lower at age 70 than at age 69 i find that both outpatient and inpatient care are price sensitive among the elderly while i find little impact on mortality and other health outcomes the results show that reduced cost sharing is associated with lower out of pocket expenditures especially at the right tail of the distribution jel g22 i11 i12 i13 i18 j14

relationship between agricultural growth and farm imports in ldcs a sims causality test based on 35 countries abstract previous empirical studies on the relationship between agricultural growth and farm imports in the ldcs suffer from serious methodological defects which to some extent may invalidate their results and interpretations this study used sims causality test to examine interactions between agricultural output and agricultural imports for 35 ldcs individually it was found that there was no causality from agricultural output to agricultural imports for a majority of countries under study for countries where agricultural growth did have a causal effect on agricultural imports the effect was positive in some countries and negative in others

synergy and congestion in the tourist destination life cycle abstract discussion of agglomeration and clustering in the tourist area life cycle talc literature has not led to a corresponding change of the principal equation used to formalize the model this paper proposes a modification that accounts for the synergies between the accommodation entertainment and other components of a tourist destination the modified model is contrasted with the original talc and estimated for a cross section of caribbean and other island destinations estimations based on visitor expenditures and experts evaluations of destination authenticity are compared the results illustrate how parameters representing synergy and congestion vary across tourism styles and time the implications for destination growth are illustrated by comparing the solution to the proposed model with the talc the model exposes a core dilemma that while destinations should realize positive synergies to achieve self sustaining growth with this threshold achieved the resulting pace of investment may drive destinations to overshoot and uneven growth

the conditions for harmony between third world agricultural development and u s farm exports during the 1960s and 1970s the growth and welfare of u s agriculture has become increasingly dependent on rapidly expanding foreign demand the origin of import demand for food and feed grains has been significantly relocated away from the more developed countries and toward the centrally planned economies the oil exporting and newly industrialized countries nics and the less developed countries ldcs between 1961 63 and 1981 83 63 of the growth in net imports of food grains originated in the developing countries dcs of which 41 was in the ldcs shane for feed grains 49 of the growth in net imports originated in the dcs of which 35 was in the nics

nonconstant reputation effect in a dynamic tourism demand model for spain abstract following the ideas of the tourism area life cycle talc theory we propose a dynamic econometric model for tourism demand where the reputation effect the effect of the lagged demand on the current tourism demand is not constant but dependent on congestion we test the model using panel data from spanish regions during the period 2000 2013 two estimations are performed depending on whether the tourists origin is domestic or international the results show that the reputation effect is not constant in both estimates supporting the idea that tourism congestion influences tourist arrivals in spain

farm development in poor countries the disputed consequences for u s farm trade a growing body of evidence suggests that farm development in poor countries is not necessarily menacing to u s farm trade to the contrary by helping to stimulate broadbased income growth in poor countries which is often followed by dietary enrichment and food import expansion farm development in poor countries can actually be beneficial to u s farm trade here we shall review some of the evidence which agricultural economists have recently put forward to support this paradoxical argument and we shall ask why this evidence has not yet been persuasive to the u s farm community in poor countries where incomes are low where diets are not yet rich and where a majority of citizens often depend upon farming for income and employment rapid agricultural development can stimulate the broad based income growth and eventually the industrial development usually necessary to turn loose pent up demands for dietary enrichment the paradoxical result can be that local food consumption may grow even more rapidly than local food production and the net farm imports of agriculturally successful developing countries can then actually increase to the presumed benefit of u s farmers a significant body of evidence has recently been assembled to document this paradoxical claim in 1979 bachman and paulino examined the trade consequences of rapid food production growth in sixteen developing countries and found that while the proportion of domestic food consumption satisfied by imports generally fell in these countries net imports of staple foods nonetheless increased annual net staple food imports in these agriculturally successful poor countries actually rose in volume by 133 between 1961 65 and 1974 76 bachman and paulino p 14 a similar pattern of rapid food import growth has more recently been documented by lee and shane in two developing countries malaysia and brazil often cited as threats to u s farm trade both of these coun

the determinants of mortality mortality rates have fallen dramatically over time starting in a few countries in the 18th century and continuing to fall today in just the past century life expectancy has increased by over 30 years at the same time mortality rates remain much higher in poor countries with a difference in life expectancy between rich and poor countries of also about 30 years this difference persists despite the remarkable progress in health improvement in the last half century at least until the hiv aids pandemic in both the time series and the cross section data there is a strong correlation between income per capita and mortality rates a correlation that also exists within countries where richer better educated people live longer we review the determinants of these patterns over history over countries and across groups within countries while there is no consensus about the causal mechanisms we tentatively identify the application of scientific advance and technical progress some of which is induced by income and facilitated by education as the ultimate determinant of health such an explanation allows a consistent interpretation of the historical cross country and within country evidence we downplay direct causal mechanisms running from income to health

consumption insurance an evaluation of risk bearing systems in low income economies the hypothesis of full risk sharing can be taken to data from low income countries and evaluate formal and informal financial systems in many contexts idiosyncratic risks are high so credit insurance arrangements could be beneficial statistical tests reveal that households in southern india take advantage of these possibilities villages in cote d ivoire and countries in thailand do not do as well the paper includes an empirical description of the devices used to smooth consumption and a theoretical discussion of private information and incentives on ideal operating systems the full information and mechanism design frameworks provide benchmarks for policy analysis

estimating the use and preservation values of national parks tourism resources using a contingent valuation method abstract the korean national parks authority has questioned whether natural resources have enough economic value to justify an increase in admission fee in the case of inadequate assistance from the government alternatively they also question whether the national parks have sufficient value to contribute to citizens welfare in order to receive continuing support from the government hence the purpose of this research is to estimate the use and preservation values of natural and or cultural resources in five distinctive national parks using a dichotomous choice contingent valuation method the empirical results show that natural and or cultural resources of the sample national parks possessed considerable use and preservation values outweighing current admission fees and maintenance costs per visitor thus these values provide enough justification for the national park authority to increase admission fees to maintain the quality of natural environment and avoid degrading natural resources in the event of no assistance by the government the findings may provide guidance to national park managers and practitioners who establish pricing policies the results also show that values of natural and or cultural resources were different across five distinctive national parks indicating the possibility of employing differential admission fees according to park characteristics

the oregon health insurance experiment evidence from the first year in 2008 a group of uninsured low income adults in oregon was selected by lottery to be given the chance to apply for medicaid this lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use financial strain and health of low income adults using a randomized controlled design in the year after random assignment the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected we find that in this first year the treatment group had substantively and statistically significantly higher health care utilization including primary and preventive care as well as hospitalizations lower out of pocket medical expenditures and medical debt including fewer bills sent to collection and better self reported physical and mental health than the control group

effects of increasing agricultural productivity in a multisectoral model for the philippines bautista r m 1986 effects of increasing agricultural productivity in a mul tisectoral model for the philippines agric econ 1 67 85 this paper investigates empirically the economy wide effects of agricultural productivity increases in the philippines reporting the results of a quantitative analysis based on a general equilibrium framework a multisectoral price endog enous model of the philippine economy is employed emphasizing not only agri culture but also other production sectors with which it closely interacts as well as the distinction between rural and urban households in their income genera tion and consumption patterns among other findings the differential effects on the real income of rural households vis a vis urban households arising from increased productivity in the various components of the agricultural production sector are striking the resulting improvements in the trade balance and national income among other macroeconomic variables are also relatively significant moreover there are significant differences in the economy wide effects among the four sectors of food and agriculture distinguished in the study particularly interesting is the highly favorable impact of rising productivity in the food pro cessing sector on agricultural crop production and rural income a linkage effect that has not received much attention in the development literature

the value of socialized medicine the impact of universal primary healthcare provision on mortality rates in turkey abstract this paper examines the impact of universal free and easily accessible primary healthcare on population health as measured by age specific mortality rates focusing on a nationwide socialized medicine program implemented in turkey the family medicine program fmp launched in 2005 assigns each turkish citizen to a specific state employed family physician who offers a wide range of primary healthcare services that are free of charge furthermore these services are provided at family health centers which operate on a walk in basis and are located within neighborhoods in close proximity to the patients to identify the causal impact of the fmp we exploit the variation in its introduction across provinces and over time our estimates indicate that the fmp caused the mortality rate to decrease by 25 6 among infants 7 7 among the elderly and 22 9 among children ages 1 4 these estimates translate into 2 6 1 29 and 0 13 fewer deaths among infants the elderly and children ages 1 4 respectively furthermore the effects appear to strengthen over time we also show evidence to suggest that the fmp has contributed to an equalization of mortality across provinces finally our calculations indicate that each family physician saves about 0 15 0 46 and 0 005 lives among infants the elderly and children ages 1 4 per province every year

causal effects of health shocks on consumption and debt quasi experimental evidence from bus accident injuries abstract endogeneity between health and wealth presents a challenge for estimating causal effects of health shocks using a quasi experimental design comprising exogenous shocks sustained as bus accident injuries in india with controls drawn from travelers on the same bus routes one year later i present new evidence of causal effects on consumption and debt using primary household survey data i find that households faced with shock related expenditures are able to smooth consumption on food housing and festivals with small reductions in educational spending debt was the principal mitigating mechanism households used leading to significantly larger levels of indebtedness

is consumption insured against illness evidence on vulnerability of households to health shocks in rural ethiopia abstract low and volatile incomes and absence of well developed financial markets make consumption smoothing an important issue in low income countries based on the theory of full insurance and using 2 years of panel data this study examines the impact of illness on the consumption of rural households and the capacity of existing risk sharing mechanisms in insuring consumption against health shocks in the rural areas of ethiopia the results show that illness has a statistically significant negative impact on the stability of consumption and the capacity of households or existing intra and interhousehold risk sharing arrangements in insuring consumption against illness varies across different consumption items the regression results show that the hypothesis of consumption insurance cannot be rejected in the case of total food consumption implying that basic items that come from own production and from external sources gifts are better insured and insensitive to the illness of the head however the

the impact of health care reform on hospital and preventive care evidence from massachusetts in april 2006 massachusetts passed legislation aimed at achieving near universal health insurance coverage the key features of this legislation were a model for national health reform passed in march 2010 the reform gives us a novel opportunity to examine the impact of expansion to near universal coverage state wide among hospital discharges in massachusetts we find that the reform decreased uninsurance by 36 relative to its initial level and to other states reform affected utilization by decreasing length of stay the number of inpatient admissions originating from the emergency room and preventable admissions at the same time hospital cost growth did not increase

the aggregate effects of health insurance evidence from the introduction of medicare this paper investigates the effects of market wide changes in health insurance by examining the single largest change in health insurance coverage in american history the introduction of medicare in 1965 i estimate that the impact of medicare on hospital spending is over six times larger than what the evidence from individual level changes in health insurance would have predicted this disproportionately larger effect may arise if market wide changes in demand alter the incentives of hospitals to incur the fixed costs of entering the market or of adopting new practice styles i present some evidence of these types of effects a back of the envelope calculation based on the estimated impact of medicare suggests that the overall spread of health insurance between 1950 and 1990 may be able to explain about half of the increase in real per capita health spending over this time period

aid food policy reform and u s agricultural interests in the third world global food economy one component of this new agricultural nationalism is a growing disenchantment with american aid to agriculture in the third world the new york times on 4 june 1987 for example featured the story world bank loans stir ire of u s farm groups in which a halfdozen leading agricultural organizations argued against aid and stimulating competition against american farmers this paper assesses the aid to agriculture question from a food policy perspective it seeks to answer two broad questions is food policy reform and agricultural growth in the third world in the interest of u s agriculture if so is aid and the conditions attached to it an effective means for achieving this reform these are immense topics and the rather bold series of propositions presented here provide only partial answers four clarifying comments seem necessary before proceeding with the analysis first the focus of this paper is on food policy and its reform such a concept is not necessarily synonymous with simply increasing agricultural output although reform typically leads to additional production food policy is instead a broader view that embraces consumption marketing and trade as well as production timmer falcon and pearson some types of policy reform might significantly improve consumption but leave agricultural production unaffected or even lowered for example many developing countries now have domestic prices higher than those in comparable world markets if reform means using world or border prices as the pricing norm an imposition of that norm would increase consumption but negatively affect farmer incentives and hence reduce the production of certain commodities

heterogeneous impact of the seguro popular program on the utilization of obstetrical services in mexico 2001 2006 a multinomial probit model with a discrete endogenous variable objective we evaluated the impact of seguro popular sp a program introduced in 2001 in mexico primarily to finance health care for the poor we focused on the effect of household enrollment in sp on pregnant women s access to obstetrical services an important outcome measure of both maternal and infant health

the effects of access to health insurance evidence from a regression discontinuity design in peru in many countries large parts of the population do not have access to health insurance peru has made an effort to change this in the early 2000s the institutional setup gives rise to the rare opportunity to study the effects of health insurance coverage exploiting a sharp regression discontinuity design we find large effects on utilization that are most pronounced for the provision of curative care individuals seeing a doctor leads to increased awareness about health problems and generates a potentially desirable form of supplier induced demand they decide to pay themselves for services that are in short supply

health shocks and consumption smoothing evidence from indonesia abstractepisodes of uninsured illness can seriously compromise a household s well being this article provides further evidence on the consequences of illness episodes on earnings and consumption in indonesia we exploit a rich panel data set that allows us to combine fixed effects and instrumental variables to address biases associated with the endogeneity of illness using deteriorations in physical functioning to measure illness for a sample of prime age individuals we find that earnings are significantly reduced however the effects on consumption are relatively small and statistically insignificant in addition we explore informal mechanisms that households may be using to smooth out the consequences of these episodes in particular we study whether households deplete liquid assets or receive transfers from noncoresident kin transfers are responsive to illness but there is no evidence of asset depletions overall our findings suggest some ability to smooth the income effects of illness on aver

what did medicare do the initial impact of medicare on mortality and out of pocket medical spending abstract we study the impact of the introduction of one of the major pillars of the social insurance system in the united states the introduction of medicare in 1965 our results suggest that in its first 10 years the establishment of universal health insurance for the elderly had no discernible impact on elderly mortality however we find a substantial reduction in the elderly s exposure to out of pocket medical expenditure risk specifically we estimate that the introduction of medicare was associated with a 40 decline in out of pocket spending for the top quartile of the out of pocket spending distribution a stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover almost two fifths of the costs of medicare these findings underscore the importance of considering the direct insurance benefits from public health insurance programs in addition to any indirect benefits from an effect on health

distance to hospital and children s use of preventive care is being closer better and for whom i introduction this article examines the effect of distance to hospital on the utilization of preventive care among children many poor children lacking alternative providers rely on hospitals and clinics for preventive care moreover in many poor neighborhoods the majority of private doctors offices are located in buildings adjacent to a hospital thus hospitals indirectly serve to attract physician services that would otherwise be lacking in the neighborhood this pattern of service provision raises several concerns first it is inefficient for children to be receiving preventive care directly from hospitals because preventive care can be delivered more cheaply in doctors offices and doctors offices also provide greater continuity of care an index of quality second even when children are receiving care in a doctor s office adjacent to a hospital continuation of that service may be jeopardized if the hospital were to close in this study we use distance to hospital as a proxy for access to medical services to examine the effect of distance to hospital on the use of preventive care services if the use of these services falls with distance other things being equal then we interpret this as evidence of lack of access to alternative providers most previous studies of the effects of distance have concentrated on specific geographical areas and or hospitalizations for specific procedures we are therefore unaware of any previous studies that have focused on the effects of distance on the utilization of preventive care among children 1 we use a national sample of children created by matching records from the national longitudinal survey of youth s child mother nlscm file with the american hospital association s 1990 hospital survey we allow the effects of distance to vary with race ethnicity insurance status and degree of urbanicity we control for other factors that might affect utilization of preventive care by including a rich set of control variables and by estimating models that include either city dummy variables or mother fixed effects in particular city dummies control for unobserved differences across cities in public transportation services and population density mother fixed effects control for unobserved differences in preferences for preventive health care robust estimates across models allow us to rule out these alternative explanations for why distance to hospital might affect different groups differentially these innovations address the important question of whether children who rely on hospitals for preventive ca re do so because they lack access to other providers we find that distance to hospital has significant effects on access to preventive care only among central city black children for these children each additional mile from the hospital is associated with a 3 decline in the probability of having had a checkup from a mean baseline of 74 this effect is comparable to the 3 increase in the probability of having a checkup which is associated with having private health insurance coverage rather than being uninsured a striking result is that among these children the size of the distance effect is similar for both the privately insured and those with medicaid suggesting that even black urban children with private health insurance have difficulty obtaining access to preventive care outside the area around hospitals thus for this group questions of access to providers may be as important as insurance coverage in predicting use of preventive care ii children who rely on hospitals for primary care prior research suggests that children who are members of minorities uninsured covered by medicaid or residing in rural areas are all more likely to rely on hospitals for preventive care this section discusses each of these groups in turn bloom 1990 demonstrates that nationally black children are twice as likely as white children to receive care in an institutional setting such as a clinic or emergency room and that they are more likely to be attended by residents than by staff physicians

insuring consumption against illness one of the most sizable and least predictable shocks to economic opportunities in developing countries is major illness we investigate the extent to which families are able to insure consumption against major illness using a unique panel data set from indonesia that combines excellent measures of health status with consumption information we find that there are significant economic costs associated with major illness and that there is very imperfect insurance of consumption over illness episodes these estimates suggest that public disability insurance or subsidies for medical care may improve welfare by providing consumption insurance

the resort development spectrum a new approach to modeling resort development abstract the role of the market has been largely ignored in existing research into the development of resort areas this paper argues that a new approach to the issue of resort development is required and proposes a new model the resort development spectrum the model is based on the operation of the market specifically focusing on the operation of the supply side tourism development in resort areas is found to occur in four phases commencing with local tourism and concluding with a fourth phase where the resort develops a strong international profile a possible fifth phase of decline stagnation or rejuvenation is also postulated the model does not find that growth is automatic or even sequential through the phases a major feature of the model is its ability to be operationalised through the use of scenario generation and multiplier analysis although these aspects of the model are not developed in this paper

the war on poverty s experiment in public medicine community health centers and the mortality of older americans this paper uses the rollout of the first community health centers chcs to study the longer term health effects of increasing access to primary care within ten years chcs are associated with a reduction in age adjusted mortality rates of 2 percent among those 50 and older the implied 7 to 13 percent decrease in one year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor non poor mortality gap for this age group large effects for those 65 and older suggest that increased access to primary care has longer term benefits even for populations with near universal health insurance jel h75 i12 i13 i18 i32 i38 j14

health shocks and consumption smoothing in rural households does microcredit have a role to play abstract this paper estimates using a large panel data set from rural bangladesh the effects of health shocks on household consumption and how access to microcredit affects households response to such shocks households appear to be fairly well insured against health shocks our results suggest that households sell livestock in response to health shocks and short term insurance is therefore attained at a significant long term cost however microcredit has a significant mitigating effect households that have access to microcredit do not need to sell livestock in order to insure consumption microcredit organizations and microcredit therefore have an insurance role to play an aspect that has not been analyzed previously

measuring progress towards universal health coverage with an application to 24 developing countries the last few years have seen a growing commitment worldwide to universal health coverage uhc yet there is a lack of clarity on how to measure progress towards uhc this paper proposes a mashup index that captures both aspects of uhc that everyone irrespective of their ability to pay gets the health services they need and that nobody suffers undue financial hardship as a result of receiving care service coverage is broken down into prevention and treatment and financial protection into impoverishment and catastrophic spending nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off nonlinear tradeoffs are allowed between and within the two dimensions of the uhc index and all indicators are expressed such that scores run from 0 to 100 and higher scores are better in a sample of 24 countries for which there are detailed information on uhc inspired reforms a cluster of high performing countries emerges with uhc scores of between 79 and 84 brazil colombia costa rica mexico and south africa and a cluster of low performing countries emerges with uhc scores in the range 35 57 ethiopia guatemala india indonesia and vietnam countries have mostly improved their uhc scores between the earliest and latest years for which there are data by about 5 points on average however the improvement has come from increases in receipt of key health interventions not from reductions in the incidence of out of pocket payments on welfare