Person:
Lindelow, Magnus
Author Name Variants
Fields of Specialization
health; social protection; public sector
Degrees
Departments
Health, Nutrition and Population
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Magnus Lindelow is the Practice Manager for Health, Nutrition and Population for Eastern and Southern Africa at the World Bank. Magnus has worked extensively in East Asia, Latin America and Africa, and most recently held the position of Program Leader for Human Development in the World Bank’s Country Office in Brazil. He has published books and research articles on impact evaluation of health sector programs, distributional issues in the health sector, public finance, service delivery, poverty and other topics. Prior to joining the World Bank, Magnus Lindelow worked as an economist in the Ministry of Planning and Finance in the Mozambique and as a consultant on public finance and health sector issues. Magnus received an undergraduate degree in economics from University College London, and earned M.Phil and D.Phil degrees in Economics from Oxford University.
Publication Search Results
1 - 10 of 32
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To Serve the Community or Oneself: The Public Servant's Dilemma
(World Bank, Washington, D.C., 2004-01)Embezzlement of resources is hampering public service delivery throughout the developing world. Research on this issue is hindered by problems of measurement. To overcome these problems, the authors use an economic experiment to investigate the determinants of corrupt behavior. They focus on three aspects of behavior: 1) Embezzling by public servants. 2) Monitoring effort by designated monitors. 3) Voting by community members when provided with an opportunity to select a monitor. The experiment allows the authors to study the effect of wages, effort observance, rules for monitor assignment, and professional norms. Their experimental subjects are Ethiopian nursing students. The authors find that service providers who earn more embezzle less, although the effect is small. Embezzlement is also lower when observance (associated with the risk of being caught and sanctioned) is high, and when service providers face an elected, rather than a randomly selected monitor. Monitors put more effort into monitoring when they face reelection, and when the public servant receives a higher wage. Communities reelect monitors who put more effort into exposing embezzlement. Framing-whereby players are referred to as "health workers" and "community members" rather than by abstract labels-affects neither mean embezzlement nor mean monitoring effort, but significantly increases the variance in both. This suggests that different types of experimental subjects respond differently to the framing, possibly because they adhere to different norms. -
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Sometimes More Equal Than Others: How Health Inequalities Depend on the Choice of Welfare Indicator
(World Bank, Washington, D.C., 2004-06)A large body of empirical work in recent years has focused on measuring and explaining socioeconomic inequalities in health outcomes and health service use. In any effort to address these questions, analysts must confront the issue of how to measure socioeconomic status. In developing countries, socioeconomic status has typically been measured by per capita consumption or an asset index. Currently, there is only limited information on how the choice of welfare indicators affects the analysis of health inequalities and the incidence of public spending. The purpose of this paper is to illustrate the potential sensitivity of the analysis of health-related inequalities to how socioeconomic status is measured. Using data from Mozambique, the paper focuses on five key health service indicators and tests whether measured inequality (concentration index) in the five health service variables is different depending on the choice of welfare indicator. The paper shows that, at least in some contexts, the choice of welfare indicator can have a large and significant impact on measured inequality in utilization of health service and on the perceived incidence of public spending. Consequently, we can reach very different conclusions about the "same" issue depending on how we define socioeconomic status. The results call for more clarity and care in the analysis of health-related inequalities and for explicit recognition of the potential sensitivity of findings to the choice of welfare measure. The results also point to the need for more careful research on how different dimensions of socioeconomic status are related, and on the pathways by which these dimensions affect health-related variables. -
Publication
Health Care Decisions as a Family Matter: Intrahousehold Education Externalities and the Utilization of Health Services
(World Bank, Washington, D.C., 2004-06)The author is concerned with the role of education as a determinant of health care choices. His central premise is that utilization of health services is determined not solely by an individual's own education, but rather by a notion of effective education, which incorporates the educational attainment of other household members. The author sets out a general framework for representing intra-household education externalities, and proposes a number of specific hypotheses concerning the way in which the education of different household members affects health care choices. He tests these hypotheses on data from Mozambique, focusing on maternity services and child immunizations. The author draws five major conclusions from the analysis. First, while maternal education seems to be the education variable of primary importance for the health care choices under consideration, the education of other household members has a significant and sometimes large effect. Second, his analysis suggests that while the education of the person (non-spouse) in the household with the highest-level education is important, the level of education of additional household members does not have an impact on health care choices. Third, the data provide no evidence of a gender difference in education externalities. Fourth, the author examines the merits of two alternative representations of the education externality, but is unable to conclude unambiguously in favor of one specification over the other. Finally, although the analysis highlights the importance of both education and a number of other explanatory variables in understanding health care choices, spatial fixed effects remain highly significant. -
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Health as a Family Matter : Do Intra-household Education Externalities Matter for Maternal and Child Health?
( 2008)This paper is concerned with the role of education as a determinant of health care choices. The central premise of the paper is that utilisation of health services is determined not solely by an individual's own education, but rather by a notion of effective education, which incorporates the educational attainment of other household members. The paper sets out a general framework for representing intra-household education externalities, and proposes a number of specific hypotheses concerning the way in which the education of different household members affects health care choices. These hypotheses are tested on data from Mozambique, focusing on maternity services, child immunisations, and child malnutrition. We draw four major conclusions from the analysis. First, while maternal education seems to be the education variable of primary importance for the health service and malnutrition variables under consideration, the education of other household members does have a significant and sometimes large effect. This is true not only for the spouse, but also the education of other individuals residing in the household. Second, the analysis suggests that while the education of the person (non-spouse) in the household with the highest level of education is important, the level of education of additional household members does not, as a rule, affect the use of services or child health outcomes. Third, the data provide no evidence of a gender difference in education externalities. Fourth, we examine the merits of two alternative representations of the education externality, but are unable to conclude unambiguously in favour of one specification over the other. -
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Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme
( 2009)In 2003, China launched a heavily subsidized voluntary health insurance program for rural residents. We combine differences-in-differences with matching methods to obtain impact estimates, using data collected from program administrators, health facilities and households. The scheme has increased outpatient and inpatient utilization, and has reduced the cost of deliveries. But it has not reduced out-of-pocket expenses per outpatient visit or inpatient spell. Out-of-pocket payments overall have not been reduced. We find heterogeneity across income groups and implementing counties. The program has increased ownership of expensive equipment among central township health centers but has had no impact on cost per case. -
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Health Facility Surveys : An Introduction
(World Bank, Washington, DC, 2003-01)Health facility surveys come in various guises. One dimension in which they vary is their motivation. Some seek to understand better links between households and providers. Others seek to understand better provider behavior and performance. Still others seek to understand the interrelationships between providers, while yet others seek to shed light on the linkages between government and providers. Health facility surveys differ too in the data they collect, in part due to the different motivations. Surveys also vary in the way they collect data, some relying on direct observation, some on record review, and some on interview. Some quality data are collected through clinical vignettes. Facility data have been put to a variety of uses, including planning and budgeting; monitoring, evaluation, and promoting accountability; and research. Lindel and Wagstaff review some of the literature under each heading and offer some conclusions regarding the current state of health facility surveys. -
Publication
Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme
(World Bank, Washington, DC, 2007-03)In 2003, after over 20 years of minimal health insurance coverage in rural areas, China launched a heavily subsidized voluntary health insurance program for rural residents. The authors use program and household survey data, as well as health facility census data, to analyze factors affecting enrollment into the program and to estimate its impact on households and health facilities. They obtain estimates by combining differences-in-differences with matching methods. The authors find some evidence of lower enrollment rates among poor households, holding other factors constant, and higher enrollment rates among households with chronically sick members. The household and facility data point to the scheme significantly increasing both outpatient and inpatient utilization (by 20-30 percent), but they find no impact on utilization in the poorest decile. For the sample as a whole, the authors find no statistically significant effects on average out-of-pocket spending, but they do find some-albeit weak-evidence of increased catastrophic health spending. For the poorest decile, by contrast, they find that the scheme increased average out-of-pocket spending but reduced the incidence of catastrophic health spending. They find evidence that the program has increased ownership of expensive equipment among central township health centers but had no impact on cost per case. -
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Health Service Delivery in China : A Literature Review
(World Bank, Washington, DC, 2006-08)The authors report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what determines their performance, and how the government can improve it. They find current performance leaves room for improvement in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector, or by simply encouraging providers-public and private-to compete with one another for individual patients. In contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid-shifting away from fee-for-service and the distorted price schedule toward prospective payments. Active purchasing by insurers could further improve outcomes. -
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The Performance of Health Workers in Ethiopia : Results from Qualitative Research
(World Bank, Washington, DC, 2005-04)Insufficient attention has been paid to understanding what determines the performance of health workers and how they make labor market choices. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. It describes performance problems identified by both health, users and health workers participating in the focus group discussions, including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption. The second part of the paper presents four structural reasons why these problems arise: (1) the ongoing transition from a health sector dominated by the public sector, toward a more mixed model; (2) the failure of government policies to keep pace with the transition toward a mixed model of service delivery; (3) weak accountability mechanisms and the erosion of professional norms in the health sector; and (4) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities. -
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For Public Service or Money : Understanding Geographical Imbalances in the Health Workforce
(World Bank, Washington, DC, 2005-08)Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, especially in developing countries. The authors investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analyzing data obtained from contingent valuation questions, they find that household consumption and the student's motivation to help the poor, which is their proxy for intrinsic motivation, are the main determinants of willingness to work in a rural area. The authors investigate who are willing to help the poor and find that women are significantly more likely to help than men. Other variables, including a rich set of psycho-social characteristics, are not significant. Finally, the authors carry out some simulations on how much it would cost to make the entire cohort of starting nurses and doctors choose to take up a rural post.