Papers by Martine Audibert
Environnement risques & santé, Jun 1, 2023
International journal of applied behavioral economics, 2017
Background: To explore the equity in health services in the rural areas, by studying the rural re... more Background: To explore the equity in health services in the rural areas, by studying the rural residents in two counties of Ningbo City, Zhejiang. Methods: Multi-stage stratified cluster random sampling method was performed to draw the study sample. Trained investigators conducted face to face interviews using a questionnaire. Rural residents were stratified into 5 income groups. Centralized index (CI) and risk ratios (RR) were used to assess the equity in health services and the impact of the New Cooperative Medical Scheme (NCMS). Results: The centralized index of the 2 weeks prevalence, two-week visiting rate and chronic disease prevalence among different income groups was − 0.0264, − 0.0076 and − 0.0160, respectively, while that of the hospitalization rate was 0.0006. The highest NCMS coverage rate, adjusted risk of disease and catastrophic health expenditure (CHE) rates were observed in lowest income groups (92.86, 4.94 and 32.21%, respectively. Two-week prevalence, chronic diseases prevalence and RR showed a declining trend with increasing income levels. Conclusion: NCMS has improved the service availability and reduced the economic burden of diseases. However, its impact on reducing the economic risk of illness and promoting equity in health services has not been significant.
Applied Health Economics and Health Policy, 2019
The purpose of this paper is to briefly present a methodological framework that does not require ... more The purpose of this paper is to briefly present a methodological framework that does not require cumbersome investigations for a first assessment of the financial sustainability of policies aiming to remove or reduce healthcare user fees (the so-called free healthcare policy [FHCP]). This paper is organized in two main sections. The first analyzes the various possibilities available to finance an FHCP. Using several scenarios, it includes a special focus devoted to the calculus of what to consider when assessing the sustainability of expanding fiscal space for financing the FHCP. The second section relies on the current FHCP being implemented in Burkina Faso to illustrate a selection of specific issues raised in the methodological framework. The results suggest that sustainable FHCP financing is not outside the range of the government but does represent a significant challenge, as it will require, both currently and in the future, complex and delicate budget trade-offs at the highest governmental levels, regardless of other policy options to be considered.
HAL (Le Centre pour la Communication Scientifique Directe), Mar 25, 2022
HAL (Le Centre pour la Communication Scientifique Directe), Dec 1, 2022
In Madagascar, malaria remains the leading cause of consultation and deaths at hospital at all ag... more In Madagascar, malaria remains the leading cause of consultation and deaths at hospital at all ages and pneumonia is one of the main causes of the under-five mortality and account for 45 % of children hospitalizations. The number of these cases and deaths has not decreased during the last ten years. This paper aims to determine the effects of malaria and pneumonia cases on rice and vanilla production and income. We used data from a cross-sectional survey conducted in 2016 by the authors on 975 rural households and 3,586 individuals of the SAVA region in the northeast of Madagascar. After checking the presence of endogeneity, ordinary least-square method was used instead of twostage least squares. Our results showed that malaria has no effect on production, and therefore does not affect income. Pneumonia has an effect on production of rice and vanilla. Moreover, the cost of malaria and pneumonia healthcare burdened by households affect their consumption by reducing expenditure on housing. There are many campaigns for the fight against malaria in Madagascar, but pneumonia prevention measures are very rare. Therefore, pneumonia should be considered in the same way as malaria due to its effects on production and investment to fight against these two diseases must be strengthened in order to decrease the costs for the households.
Revue d’économie du développement, 2008
Decentralization in China in the 1990s placed township hospitals (TH) at the heart of rural Chine... more Decentralization in China in the 1990s placed township hospitals (TH) at the heart of rural Chinese health care. We collected data from a sample of 21 THs in Shandong province in order to analyze the determinants of their activities and assess their efficiency during the period 1986-2000. Among other results, and controlling for other factors, we find that local income per capita in the TH area of activity as well as the perceived attractiveness of THs have positive effects on the number of outpatients and inpatients treated. The price of care has a negative effect and existing medical insurance schemes have no significant effect. The partial vertical integration of village health stations with THs seems to have slowed TH activity. The efficiency of THs has improved, with some convergence in our sample. Financial constraints, human resource issues, and institutional factors related to the regulation of hospitals by the supervisory body and to the governance of this body played important roles in this overall positive evolution.
PubMed, Sep 1, 1983
The state of the S. haematobium infection in North Cameroon seemed sufficiently well known to reg... more The state of the S. haematobium infection in North Cameroon seemed sufficiently well known to regard as negligible the risks involved in planning hydro-agricultural plants. However, a series of field-studies conducted by the authors in one of these sites (SEMRY II, North of Yagoua, in the Mayo Danaï area) has shown that the spread of this disease varies widely from village to village. It is sometimes absent, and on average, it rarely exceeds 15% of the sample (approximately 4,000 people, spread over 28 survey areas). This result is obtained using a representative sample of about 70,000 people, directly or indirectly affected by the hydro-agricultural project. The technique used was a simple centrifugation, and no egg count was made. Two malacological investigations performed in the same area complemented the parasitological inquiry. Comparison of these results with previous works shows that the latter used too few observations, the statistical representativity of which was never assured. On the other hand, recent evaluations, done independently of those reported in this paper, but which are limited to a few villages, confirm that the present infection rate for S. haematobium is appreciably lower than what is believed, and that it varies considerably from village to village. This re-evaluation of the problem leads us to conclude that the hydroagricultural plants, which are intended to develop irrigated rice-growing, might cause a considerable upsurge of the disease; and that this risk should be prevented by setting up specific control programs.
Revue d'économie du développement, 1999
The Malaria Effects on Technical Efficiency of Cotton Growers in Northern Côte d'Ivoire This ... more The Malaria Effects on Technical Efficiency of Cotton Growers in Northern Côte d'Ivoire This article assess the role of malaria on the agricultural development and more precisely on technical efficiency in the context of cotton crop in the Korhogo region in the North of Côte d'Ivoire. The stochastic frontier production function incorporating a model for technical inefficiency effects (Battese and Coelli, 1995) was applied in order to check the hypothesis that the efficiency deviations between farmers should be explained by the disparity of the presence and the severity of malaria infection among the farmers and their family. Field data was collected by the authors between March 1997 and February 1998 on 700 rural households living in three production systems differently exposed to the malaria risk. Three malaria indicators were used. There were the prevalence, in the active (11-55 years old) family members of the farm, of parasitemia, high and very high densities of Plasmodium falciparum. The results of the model and the distribution of farm efficiency according to the presence and the severity of malaria infection obviously determine a critical threshold above which malaria has a negative effect on technical efficiency in the cotton crop. Then, farm households in which the proportion of actives with a high density of Plasmodium falciparum (more than 499 parasites/pl of blood) was higher or equal to 25 %, were less efficient than the farm households in which this density is lower.
American Journal of Tropical Medicine and Hygiene, Jun 1, 1990
Field studies of a rice irrigation project in Mayo-Danai, North Cameroon permitted a direct compa... more Field studies of a rice irrigation project in Mayo-Danai, North Cameroon permitted a direct comparison between pre- and post-development data relating to schistosomiasis and malaria infection. A stratified sample of 4,000 inhabitants, representing 8% of the population living in 28 areas at the time of the first survey, was investigated 5 times between 1979 and 1985. Due to the significant population increase since 1982, 1,500 persons were added to the initial sample. The prevalence of schistosomiasis and malaria remained constant over the 6 years. No changes in the transmission sites were observed. Malacological investigations showed a decrease in the snail population in the project area. Sanitation activities (i.e., drain cleaning and well construction) and decreased rainfall contributed to this situation. The prevalence of infection among the migrants was low. High prevalence of schistosomiasis was found only in villages located along a previously contaminated temporary river.
HAL (Le Centre pour la Communication Scientifique Directe), Dec 6, 2007
Social Science & Medicine, Feb 1, 1993
Dracunculiasis prevention should be simple: in a population at risk, everyone may be protected by... more Dracunculiasis prevention should be simple: in a population at risk, everyone may be protected by the filtration of drinking water. The research described in this paper allowed the authors to follow the acceptance of new information by villagers in nine localities in Mali. Two strategies were studied: safe water supply (bore-hole or cement lined wells) plus health education on the one hand, and health education alone (based on filtration) on the other. Safe water supply is undoubtedly an effective strategy whereas the success of the health education intervention is uncertain. This experience showed that health education as the only means of control failed due to a lack of social cohesion or of coordinated group-action. Also, when dracunculiasis control is not a population's priority goal, the constraints on systematic filtration are too great and a tendancy to discontinue the filtration process occurs. On the other hand, when dracunculiasis is considered to be a serious problem by the population, new information about systematic filtration is better assimilated and leads to behavioural changes. In order that the goal of eradicating dracunculiasis by 1995 should not be an utopic dream, it is necessary to prioritise the allocation of clean rural water supply projects only to those endemic villages where the conditions that allow for health education to be successful are met.
RePEc: Research Papers in Economics, 2020
RePEc: Research Papers in Economics, 2020
RePEc: Research Papers in Economics, Jul 1, 2017
The objective of this paper is twofold: 1) to fill the gap in the health care literature with the... more The objective of this paper is twofold: 1) to fill the gap in the health care literature with the estimation of the price and distance effects on health care provider choices by households in the presence of varying demand heterogeneity, 2) to contribute to estimation robustness by confronting the performance of the mixed multinomial logit (MMNL) and the multinomial logit (MNL). We built a database of two samples of patients surveyed within the same regions in rural China over a time interval of 18 years, and presumed varying demand heterogeneity due to income increase and people aging. We find that while the mean price and distance negative effects on patients choice were present in both time periods, their differences in heterogeneity, which were confirmed with the MMNL, could have crucial importance in avoiding erroneous policy making based merely on mean price and distance effects. We also find that while both the MNL and the MMNL are able to predict price and distance effects with low heterogeneity, only the MMNL appears able to detect the price effect when heterogeneity is high. This finding has policy implications and suggests using caution when interpreting estimation results with the MNL in cases of high heterogeneity.
RePEc: Research Papers in Economics, Feb 1, 2017
Since the early 2000s, China has embarked on a major reform program in the field of health. Three... more Since the early 2000s, China has embarked on a major reform program in the field of health. Three are essential and linked: rebuilding a new health insurance system in rural areas, restructuring the organization and management of hospitals, halting the sharp rise in drug prices. To cope with the rising price of drugs, in 2009 the Chinese government launched a large pharmaceutical reform. Its key element is the implementation of a National Essential Medicine List (NEML), leading to a reorientation of incentives for health services financing. Health facilities are no longer allowed to make any profit on drug sales (“zero mark-up policy”), while this used to be their main source of revenue. Authorities have implemented different compensation schemes. In the context of redesigning the financing structure of health care facilities, it is crucial to understand how the NEML reform has affected—or not—the activity and efficiency of health care facilities, since the search for greater efficiency in the health system is a transversal and underlying objective of the three reforms mentioned above.This study relies on survey data from a sample of 30 randomly selected Township Hospitals (TH) in rural area from the prefecture of Weifang, in the Shandong province. Using a two-stage procedure, the study aims at assessing the technical efficiency scores of Township Hospitals and then at identifying the determinants of this efficiency. The first stage is realized with a non-parametric frontier approach, “partial frontier” method (order-m), to deal with the problem of dimensionality of the sample. The identification of the determinants of efficiency is made with fractional regressions (Ramalho, 2011). Results show that the average efficiency remains constant from 2006 to 2009 and 2010 to 2012, at around 0.65. The most significant and robust factors of technical efficiency are the share of subsidies in the TH incomes (negative effect) and the number of covered inhabitants per bed (positive effect). The study suggests that even after the implementation of the drug reform, a “soft budget constraint” effect remains, as well as financial barriers to universal access to healthcare (importance of demand-side determinants) and a phenomenon of oversizing of some THs.
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Papers by Martine Audibert