Person:
Gragnolati, Michele

Health, Nutrition and Population

Fields of Specialization

Demography, Health economics, Population studies, Aging, Development economics

Departments

Health, Nutrition and Population

Last updated: January 31, 2023

Biography

Michele Gragnolati currently serves as the Manager for Strategy, Operations and Global Engagement in the Health, Nutrition and Population Global Practice. He joined the World Bank as a Young Professional in 1998 and since 2000, he served first as an economist with the health sector in Latin America and South Asia, and later as program leader for Human Development for the Western Balkans, Brazil, and Argentina, Paraguay and Uruguay. His last position was as Global Lead for Population and Development and he worked mostly on issues related to high fertility and rapid population growth in Sub-Saharan Africa. Before coming back to HQ in Washington, DC, Michele was based in Sarajevo, Brasilia and Buenos Aires. Michele has published on different topics, including methodological and statistical demography, poverty during the East Asia financial crisis, malnutrition in Central America and India, the impact of health expenditures on poverty in former Yugoslavia, the economics of demographic change in Africa and the socioeconomic implications of population aging in Argentina, Brazil and Uruguay. Economist graduated from Luigi Bocconi Commercial University (Italy), Gragnolati has also a Master’s Degree in Population and Development from the London School of Economics (Great Britain) and a Ph.D. in Demography from the University of Princeton (USA). Michele speaks Italian, English, Spanish, French and Portuguese.

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Publication Search Results

Now showing 1 - 10 of 13

Catastrophic and Impoverishing Effects of Health Expenditure : New Evidence from the Western Balkans
(2011) Bredenkamp, C.; Gragnolati, M.
This paper investigates the effect of health-related expenditure on household welfare in Albania, Bosnia and Herzegovina, Montenegro, Serbia and Kosovo, all of which have undertaken major health sector reform. Two methodologies are used: (i) the incidence and intensity of 'catastrophic' health care expenditure, and (ii) the effect of out-of-pocket payments on poverty headcount and poverty gap measures. Data are drawn from the most recent Living Standards and Measurement Surveys, 2000-05. While our analyses are not without their limitations, and the lack of comparability across instruments precludes a direct comparison across countries, there is no doubt that health expenditure contributes substantially to the impoverishment of households-increasing the incidence of poverty and pushing poor households into deeper poverty-in each country. Both the catastrophic and the impoverishing effects of health expenditures are particularly severe in Albania and Kosovo. Transportation expenditure accounts for a large share of total health expenditures, especially in Albania and Serbia. Informal payments are substantial in all countries, and are particularly high in Albania. As countries in the sub-region continue the process of health system reform, an important policy question should be how to protect vulnerable groups from the catastrophic and impoverishing effects of health care expenditure.
Growing Old in an Older Brazil : Implications of Population Ageing on Growth, Poverty, Public Finance, and Service Delivery
(World Bank, 2011-09-07) Jorgensen, Ole Hagen; Gragnolati, Michele; Rocha, Romero; Fruttero, Anna
This chapter introduces the main issues associated with population aging, many of which will be investigated in detail throughout the volume. The next section describes the demographic transformation that Brazil has been experiencing and highlights its specific features, including a very rapid population aging process in the next few decades. Then the main economic framework behind this work, the life cycle theory according to which individuals' economic behavior varies according to their age, is discussed. The section after that introduces the first and second demographic dividends associated with the changing population age structure that accompanies the demographic transition of any country. Next covered is how poverty is linked to the life cycle in Brazil and the role of public transfers in reducing poverty among different age groups, followed by an investigation of how public expenditures vary across age groups and generations and what makes Brazil distinct from comparable OECD (Organization for Economic Co-operation and Development) and Latin American countries. Concluding the chapter are the main findings of the report.
Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
(Washington, DC: World Bank, 2013-06-13) Couttolenc, Bernard; Gragnolati, Michele; Lindelow, Magnus
It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.
Enhancing Efficiency and Equity : Challenges and Reform Opportunities Facing Health and Pension Systems in the Western Balkans
(World Bank, Washington, DC, 2008-09) Ramljak, Vedad; Bredenkamp, Caryn; Gragnolati, Michele; Bredenkamp, Caryn; Gragnolati, Michele; Ramljak, Vedad
This collection of papers explores the major challenges to the sustainability of health and pension system financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia, and the province of Kosovo. It focuses on how the incentives created by the different elements of the financing arrangements affect the behavior of providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The volume commences with an analysis of healthcare financing, exploring patterns of healthcare expenditure, and examining the key drivers of current healthcare expenditure and the most significant barriers to revenue generation. Subsequent chapters give special attention to provider payment mechanisms and the pharmaceutical sector. Equity considerations are highlighted in a chapter that explores the protection that is offered against the financial impact of health expenditures. With respect to the pension sector, the volume provides an overview of national pension systems and outlines the main challenges to achieving a sustainable balance between pension benefits and costs. The analyses of the health and pension reform process are placed within the context of the labor market challenges in the sub-region, especially as they relate to the ability to raise revenue for health and pensions through payroll contributions. All chapters conclude by identifying some reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their systems. Data are drawn from international databases, country institutions, and household surveys.
The Impoverishing Effect of Adverse Health Events : Evidence from the Western Balkans
(World Bank, Washington, DC, 2007-12) Mendola, Mariapia; Bredenkamp, Caryn; Gragnolati, Michele
This paper investigates the extent to which the health systems of the Western Balkans (Albania, Bosnia and Herzegovina, Montenegro, Serbia, and Kosovo) have succeeded in providing financial protection against adverse health events. The authors examine disparities in health status, healthcare utilization, and out-of-pocket payments for healthcare (including informal payments), and explore the impact of healthcare expenditures on household economic status and poverty. Methodologies include (i) generating a descriptive assessment of health and healthcare disparities across socioeconomic groups, (ii) measuring the incidence and intensity of catastrophic healthcare payments, (iii) examining the effect of out-of-pocket payments on poverty headcount and poverty gap measures, and (iv) running sets of country-specific probit regressions to model the relationship between health status, healthcare utilization, and poverty. On balance, the findings show that the impact of health expenditures on household economic wellbeing and poverty is most severe in Albania and Kosovo, while Montenegro is striking for the financial protection that the health system seems to provide. Data are drawn from Living Standards and Measurement Surveys.
Sustainability of Healthcare Financing in the Western Balkans : An Overview of Progress and Challenges
(World Bank, Washington, DC, 2007-10) Bredenkamp, Caryn; Gragnolati, Michele
This paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels - while similar to that in EU countries as a share of GDP - are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys.
India's Undernourished Children : A Call for Reform and Action
(Washington, DC: World Bank, 2006) Shekar, Meera; Gragnolati, Michele; Das Gupta, Monica; Bredenkamp, Caryn; Lee, Yi-Kyoung
The prevalence of child undernutrition in India is among the highest in the world; nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this book explores the dimensions of child undernutrition in India and examines the effectiveness of the Integrated Child Development Services (ICDS) program, India's main early child development intervention, in addressing it. Although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged behind those achieved by other countries with similar economic growth. Nutritional inequalities across different states and socioeconomic and demographic groups remain large. Although the ICDS program appears to be well-designed and well-placed to address the multi-dimensional causes of malnutrition in India, several problems exist that prevent it from reaching its potential. The book concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation.
India's Undernourished Children : A Call for Reform and Action
(World Bank, Washington, DC, 2005-08) Shekar, Meera; Gragnolati, Michele; Das Gupta, Monica; Lee, Yi-Kyoung; Bredenkamp, Caryn
This paper explores the dimensions of child undernutrition in India, and examines the effectiveness of the Integrated Child Development Services (ICDS) program in addressing it. The paper finds that although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged far behind that achieved by other countries with similar economic growth rates. Nutritional inequalities across different states, socioeconomic and demographic groups are large - and, in general, are increasing. The study also finds that the ICDS program appears to be well-designed and well-placed to address the multidimensional causes of malnutrition in India. However, there are several mismatches between the program's design and its actual implementation that prevent it from reaching its potential. The paper concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation.
Nonlinear Effects of Altitude on Child Growth in Peru – A Multilevel Analysis
(World Bank, Washington, DC, 2006-01) Marini, Alessandra; Gragnolati, Michele
Growth at high altitude has been the object of many investigations after experimental studies on animals showed that hypoxia at high altitude slows growth. Many studies have also looked at the Andean populations and found different results. Even though a few studies find that individuals living at high altitudes are smaller than the ones living at low altitudes, a significant group of studies does not reveal such a clear relationship. This study focuses on Peru, a country characterized by a diverse territory, great altitude variations, and a population with a wide socioeconomic gradient. The analysis differs from previous studies in three ways. First, in an attempt to reconcile the main findings of the biological literature with the economic models of child health, it explores the relationship between altitude and child health within a multivariate framework. Second, it benefits from a large spectrum of altitude data and does not concentrate on one or two isolated villages. Third, it takes into account the cluster nature of the data and controls for correlation of variables in the same cluster through multilevel statistical modeling. After controlling for characteristics of the children, families, and communities, the data show a significant nonlinear relationship between altitude and child nutritional status. Peruvian children living at medium/high altitudes appear to be worse off than children living at extremely high altitudes, where the negative effect of hypoxia on growth could be compensated by other favorable health and environmental conditions.
Health and Poverty in Guatemala
(World Bank, Washington, DC, 2003-01) Marini, Alessandra; Gragnolati, Michele
Unlike many other countries in Latin America, Guatemala is only at the beginning of the demographic, and epidemiological transition. The population is young, is growing rapidly, and is still primarily rural. Guatemala is among the worst performers in terms of health outcomes in Latin America, with one of the highest infant mortality rates, and one of the lowest life expectancies at birth. Major causes of death in Guatemala still include treatable, and communicable diseases, such as diarrhea, pneumonia, cholera, malnutrition, and tuberculosis. A significant share of Guatemalans lack access to health care services. A combination of both supply- and demand-side constraints limit the ability of households to seek health care services in Guatemala, with supply-side constraints playing a more dominant role in rural areas than urban. Some progress has been made in reforming the health sector. Important steps have been taken on the institutional side, with health being one of the pilot ministries to decentralize financial management under the Integrated System for Health Care (SIAS program). Public spending has shifted toward preventive care, which is essential for treating the health problems faced by the poor. Despite these efforts, spending and health outcomes has not improved significantly. In addition, public spending on health is not well targeted. Overall, public health spending benefits the highest quintiles disproportionately, By type of facility, public spending on hospitals is by far the more regressive.