Quantifying the influence of informal payments on self-rated health: evidence from 26 post-communist countries.

In contrast to previous studies that have focused on proximal outcomes such as access to and the utilization of healthcare, this study establishes and quantifies the influence of informal payments (IP) directly on population self-rated health, which can be considered the ultimate outcome. More specifically, we examine how making informal payments influences self-rated health by testing several theoretically grounded explanations of the influence of making IP. Using the quasi-experimental instrumental variable technique increases the likelihood that our findings are not the result of reverse causality, omitted variable problem and measurement error. Our main finding is that overall, making informal payments have a negative influence on self-rated health. However, this influence is higher for men, those who are poorer, live in rural areas, have a university education and have lower social capital. Theoretical approaches that have stood out in explanations regarding the effects of making IP on self-rated health are Public Choice Theory, Institutional Theory, and Sociological Theories of Differences in Life Opportunities, Social Determinants of Health and Social Capital.

How Different Motivations for Making Informal Out-Of-Pocket Payments Vary in Their Influence on Users' Satisfaction with Healthcare, Local and National Government, and Satisfaction with Life?

BACKGROUND: The dominant view in the literature is that informal payments in healthcare universally are a negative phenomenon. By contrast, we theorize that the motivation healthcare users for making informal payments (IP) can be classified into three categories: (1) a cultural norm, (2) "grease the wheels" payments if users offered to pay to get better services, and (3) "sand the wheels" payments if users were asked to pay by healthcare personnel or felt that payments were expected. We further hypothesize that these three categories of payments are differently associated with a user's outcomes, namely, satisfaction with healthcare, local and national government, satisfaction with life, and satisfaction with life of children in the future. METHODS: We used microdata from the 2016 Life-in-Transition survey. Multivariate regression analysis is used to quantify relationships between these categories of payments and users' outcomes. RESULTS: Payments that are the result of cultural norms are associated with better outcomes. On the contrary, "sand the wheel" payments are associated with worse outcomes. We find no association between making "grease the wheels" payments and outcomes. CONCLUSIONS: This is the first paper which evaluates association between three different categories of informal payments with a wide range of users' outcomes on a diverse sample of countries. Focusing on informal payments in general, rather than explicitly examining specific motivations, obscures the true outcomes of making IP. It is important to distinguish between three different motivations for informal payment, namely, cultural norms, "grease the wheels," and "sand the wheels" since they have varying associations with user outcomes. From a policy making standpoint, variation in the links between different motivations for making IP and measures of satisfaction suggest that decision-makers should put their primary focus on situations where IP are explicitly asked for or are implied by the situation and that they should differentiate this from cases of gratitude payments. If such measures are not implemented, then policy makers may unintentionally ban the behaviour that is linked with increased satisfaction with healthcare, government, and life (i.e., paying gratitude).

Women's decision-making autonomy and utilization of antenatal, natal and post-natal healthcare services: Insights from Tajikistan's national surveys.

BACKGROUND: The purpose of this article is to investigate the link between women's autonomy and their utilization of antenatal, natal and post-natal healthcare services in Tajikistan. Previous studies focused only on a single dimension of such services, for instance, utilization of antenatal care. By contrast, we explore antenatal, natal and post-natal healthcare services utilization using the number of indicator for each of the dimensions. METHODS: Data come from two national surveys that were conducted in 2012 and 2017. The target population is women of reproductive age (16-49) who were married or cohabitating with a partner (N = 7540). Several regression models were estimated to quantify association between women's autonomy and the utilization. RESULTS: Lack of women's autonomy is associated with a lower probability of: (a) having had at least four antenatal check-ups during pregnancy, (b) beginning first antenatal check-up early, (c) delivering in a healthcare facility, (d) having the skilled attendance during pregnancy, (e) having a mother post-delivery check-up, and (f) having a child post-delivery check-up. The size effect of women's autonomy is stronger than that of well-developed precursors of utilization such as poverty and mothers' education. CONCLUSION: Women autonomy should be improved to achieve higher rates of child and maternal healthcare utilization. Studies of maternal and child healthcare utilization should control explicitly for women's autonomy.

Influence of height on likelihood of employment, occupational sorting, and earnings in 27 post-communist countries.

OBJECTIVES: We study the influence of height on labour market outcomes using micro-data from a recent survey that cover 27 post-communist countries. Specifically, we focus on the influence of height on three dimensions of labour market outcome: (1) likelihood of employment, (2) occupational sorting, and (3) earnings. METHODS: We use micro-data from 2016 Life-In-Transition survey (LITS) which was jointly conducted by the European Bank for Reconstruction and Development and the World Bank. We run several types of regression to show how height influences (1) likelihood of employment, (2) occupational sorting, and (3) earnings. RESULTS: When controlling for a comprehensive set of covariates, for each 10 cm increase in height, the probability of getting a job increases by 1% points for males and by 3 for females. Equally, for each 10 cm increase in height, the probability of getting a job increases by 2% points in urban areas and rural areas. Our findings demonstrate that taller women and men are more likely: (a) being an employer rather than an employee; (b) to be employed in higher-paid and more prestigious sectors of finance, insurance, and real estate; (c) to be employed in private enterprises. Finally, when occupational sorting and socio-demographics are controlled for, a 10 cm increase in height results in a 5% increase in earning for men, and a 12% increase in earnings for women. CONCLUSIONS: Using a diverse sample of 27 post-communist countries, we found that taller individuals have better labour market outcomes in terms of employment, occupational sorting, and earnings.

Height and life satisfaction: Evidence from 27 nations.

OBJECTIVES: To evaluate the effect of height on life satisfaction. METHODS: We use data from a recent multi-country survey that was conducted in 27 nations. RESULTS: Our main finding is that height does have a strong positive effect on life satisfaction. These findings remain positive and significant when we use a comprehensive set of well-known covariates of life-satisfaction at both the individual and country levels. These findings also remain robust to alternative statistical specifications. CONCLUSIONS: From a theoretical standpoint, our findings suggest that height is important in explaining life-satisfaction independent of other well-known determinants. From a methodological standpoint, the findings of this study highlight the need to explicitly control for the effect of heights in studies on subjective well-being, happiness, and life-satisfaction.

The Effects of Healthcare Quality on the Willingness to Pay More Taxes to Improve Public Healthcare: Testing Two Alternative Hypotheses from the Research Literature.

The research literature discusses two opposite hypotheses regarding the possible effects of healthcare quality on the willingness to pay more taxes to improve public healthcare. One hypothesis theorizes that a lower quality of public healthcare may weaken the willingness to pay more taxes towards improving it. Another hypothesis posits that a low quality of public healthcare may strengthen the willingness to pay more taxes towards improving it. We tested both hypotheses on a diverse sample of 27 post-communist countries within Eurasia and Southern and Eastern Europe over a period of five years. We apply a binary logistic model for each country under investigation. The model is estimated by regressing the willingness to pay more taxes on six dimensions of quality, while controlling for covariates and the dummy for 2016. We found empirical support for both hypotheses, and hence none of the hypotheses gleaned from the literature is a clear "winner." However, we also found that the situation is less straightforward and more nuanced than is usually acknowledged within the literature. Our findings also suggest the effect is specific with respect to both a quality dimension and a country tested.

Poverty Does Make Us Sick.

This study evaluates the direct causal effects of household wealth on health. We discuss several specific mechanisms that that could relate poverty with worse health and hypothesize that poverty will undermine population health. This hypothesis was tested based on data drawn from a recent cross-country survey in 12 post-Soviet countries and Mongolia using classic regression (OLS) and instrumental variable 2SLS regressions. The results indicate that poverty does indeed lead to worsening health. This negative effect of poverty on health remains unchanged after controlling for a wide range of individual characteristics, healthcare performance indicators, trust in individuals, government, parliament, and political parties, as well as country-level unobserved characteristics. Using an instrumental variable increases our confidence in being able to isolate the effects of poverty on health status and confirms that our results are not due to endogeneity. In addition, the strong negative effect of poverty on health remains robust to the use of a set of country-level aggregated indicators (e.g. GDP and Gini) instead of country dummies, the employment of a subjective self-assessment indicator of poverty instead of an objective one, and an alternative conceptualization of health status as a binomial variable (for bad and very bad health) instead of a continuous one.

Effects of the 2008 global financial crisis on population health.

We compare the transmission channels through which the 2008 global financial crisis affected health. We find that postponing or skipping visits to the doctor after falling ill and stopping buying regular medication had the strongest negative effects on health, followed by a reduced consumption of staple foods, utilities being cut, being forced to move, and having to sell assets. In comparison, experiencing cuts in TV, phone, and internet services, as well as delaying payments for utilities had relatively weaker negative impacts. In contrast, having a household head or household member lose a job also had negative effects on health status, although this effect was relatively lower. Finally, a reduced flow of remittances had the weakest negative effect.

Do HIV prevention interventions in Asia lead to increase in condom utilization?: A meta-analysis study.

This meta-analytic review synthesizes the findings of published independent studies that assessed the effectiveness of HIV prevention interventions in promoting condom usage in Asia. We focused on 20 studies that used randomized control studies to establish whether HIV prevention interventions lead to increased condom utilization. As compared with the average control group client, we found that 68% of the clients who participated in an intervention group increased their condom usage. The effectiveness of HIV prevention intervention is not related to country and rural-urban contexts, to male-female samples, to the type of outcome measured, or the timing of the latest follow-up assessment. The implications of these findings are that policy-makers, health administrators, and international donors should view behavioral HIV prevention interventions as an effective approach through which to increase condom usage in order to reduce the HIV infection rate in Asia.

A healthy weight improves life satisfaction.

In this study, we examine the effects of having a healthy weight in form of a healthy body mass index (BMI) on life satisfaction using the data from a diverse sample of 27 post-communist transitional countries. We find that a healthy BMI significantly raises life satisfaction, while an increase in BMI reduces life satisfaction. We also find that the positive effect of a healthy BMI on life satisfaction substantially diminishes as the political and economic situation improves. Equally, the positive effect of healthy BMI on life satisfaction is considerably lower for those who exhibit higher levels of institutional trust and express trust in government, parliament, and political parties. Classic regression models such as ordinary least squares (OLS) and ordered probit significantly underestimate the true effect of healthy BMI on life satisfaction. Such results suggest that unobserved confounders, measurement error, or their interplay appear to be the main source (s) of bias that eventually lead to a significant underestimation of the true effect of BMI on life satisfaction through classic regression models.

Who wants to pay more taxes to improve public health care?

We study the factors that influence willingness to pay to improve public health care in 29 post-communist countries, Eastern and Southern Europe, and Eurasia using 2 up-to-date cross-sectional surveys conducted in 2010 and 2016 (N = 34 768). Three hypotheses received full degree of support through empirical analysis: increase in satisfaction with health care, university education, and higher level of wealth positively associated with willingness to pay in all regions. In comparison, having a higher level social trust and adhering to left-leaning ideological position strengthens support for public health care in Southern Europe and Eurasia only, while having a higher level of institutional trust strengthens support for public health care in Eastern Europe and Eurasia only.

Does social trust increase willingness to pay taxes to improve public healthcare? Cross-sectional cross-country instrumental variable analysis.

The purpose of this paper is to investigate the effect of social trust on the willingness to pay more taxes to improve public healthcare in post-communist countries. The well-documented association between higher levels of social trust and better health has traditionally been assumed to reflect the notion that social trust is positively associated with support for public healthcare system through its encouragement of cooperative behaviour, social cohesion, social solidarity, and collective action. Hence, in this paper, we have explicitly tested the notion that social trust contributes to an increase in willingness to financially support public healthcare. We use micro data from the 2010 Life-in-Transition survey (N = 29,526). Classic binomial probit and instrumental variables ivprobit regressions are estimated to model the relationship between social trust and paying more taxes to improve public healthcare. We found that an increase in social trust is associated with a greater willingness to pay more taxes to improve public healthcare. From the perspective of policy-making, healthcare administrators, policy-makers, and international donors should be aware that social trust is an important factor in determining the willingness of the population to provide much-needed financial resources to supporting public healthcare. From a theoretical perspective, we found that estimating the effect of trust on support for healthcare without taking confounding and measurement error problems into consideration will likely lead to an underestimation of the true effect of trust.