Person: Sautmann, Anja
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Sautmann, Anja, Sautmann, A.
Fields of Specialization
Health Care Demand, Economic Preferences, Experimental Methods, West Africa
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Last updated:November 28, 2025
Biography
Anja Sautmann is a Research Economist in the World Bank's Development Research Group (Human Development Team). Her research asks how households and individuals make decisions, from healthcare for children to daily consumption to marriage, and how incentives and individual behavior shape optimal policy design. A lot of her work concerns demand for public primary care in Mali. Before joining the World Bank, Anja was an Assistant Professor at Brown University (2010-2017) and the Director of Research, Education, and Training at the Abdul Latif Jameel Poverty Action Lab at MIT (2017-2020). She received her Ph.D. in Economics from New York University. She is an affiliate of the CESifo research network.
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Publication Improving Effective Coverage in Health: Do Financial Incentives Work?(Washington, DC: World Bank, 2022-05-11) de Walque, Damien; Kandpal, Eeshani; Wagstaff, Adam; Friedman, Jed; Neelsen, Sven; Piatti-Fünfkirchen, Moritz; Sautmann, Anja; Shapira, Gil; Van de Poel, EllenIn many low- and middle-income countries, health coverage has improved dramatically in the last two decades, but health outcomes have not. As such, effective coverage -- a measure of service delivery that meets a minimum standard of quality -- remains unacceptably low. This Policy Research Report examines one specific policy approach to improving effective coverage: financial incentives in the form of performance-based financing (PBF) or financial incentives to health workers on the front lines. The report draws on a rich set of rigorous studies and new analysis. When compared to business-as-usual, in low-income settings with centralized health systems PBF can result in substantial gains in effective coverage. However, the relative benefits of PBF are less clear when it is compared to two alternative approaches, decentralized facility financing which provides operating budget to frontline health services with facility autonomy on allocation, and demand-side financial support for health services (i.e., conditional cash transfers and vouchers). While PBF often results in improvements on the margins, closing the substantial gaps in effective health coverage is not yet within reach for many countries. Nonetheless, there are important lessons learned and experiences from the roll-out of PBF over the last decade which can guide health policies into the future.Publication Do Patients Value High-Quality Medical Care? Experimental Evidence from Malaria Diagnosis and Treatment(Washington, DC: World Bank, 2024-04-05) Lopez, Carolina; Sautmann, Anja; Schaner, SimoneCan better information on the value of diagnostic tests improve adoption and help patients recognize higher quality of care? In a randomized experiment in public clinics in Mali, providers and patients received tailored information about the importance of rapid diagnostic tests (RDT) for malaria. The provider training increased reliance on RDTs and improved the match between a patient’s malaria status and treatment with antimalarials by 15–30 percent. Nonetheless, patients were significantly less satisfied with the care they received, driven by those whose prior beliefs did not match their malaria status. The patient information intervention reduced malaria testing and did not improve treatment outcomes or patient satisfaction. These findings are consistent with highly persistent patient beliefs and distrust of the promoted diagnostic technology, which translate into low demand and limit patients’ ability to recognize improved quality of care.Publication The Effects of Community Health Worker Visits and Primary Care Subsidies on Health Behavior and Health Outcomes for Children in Urban Mali(Published by Oxford University Press on behalf of the World Bank, 2023-05-17) Dean, Mark; Sautmann, AnjaSubsidized primary care and community health worker (CHW) visits are important demand-side policies in the effort to achieve universal health care for children aged under 5. Causal evidence on the interaction between these policies is still sparse. This paper reports the effects on diarrhea prevention, curative care, and incidence as well as anthropometrics for 1,649 children from a randomized controlled trial in Bamako that cross-randomized CHW visits and access to free health care. CHW visits improve prevention and subsidies increase the use of curative care for acute illness, with some indication of positive interaction effects. There is no evidence of moral hazard, such as reduced preventive care among families receiving the subsidy. Although there are no significant improvements in malnutrition, diarrhea incidence is reduced by over 70 percent in the group that receives both subsidies and CHWs. Positive effects are concentrated among children under age 2.Publication A Metadata Schema for Data from Experiments in the Social Sciences(World Bank, Washington, DC, 2023-02) Cavanagh, Jack; Fliegner, Jasmin Claire; Kopper, Sarah; Sautmann, AnjaThe use of randomized controlled trials (RCTs) in the social sciences has greatly expanded, resulting in newly abundant, high-quality data that can be reused to perform methods research in program evaluation, to systematize evidence for policymakers, and for replication and training purposes. However, potential users of RCT data often face significant barriers to discovery and reuse. This paper proposes a metadata schema that standardizes RCT data documentation and can serve as the basis for one—or many, interoperable —data catalogs that make such data easily findable, searchable, and comparable, and thus more readily reusable for secondary research. The schema is designed to document the unique properties of RCT data. Its set of fields and associated encoding schemes (acceptable formats and values) can be used to describe any dataset associated with a social science RCT. The paper also makes recommendations for implementing a catalog or database based on this metadata schema.Publication Multiple Price Lists for Willingness to Pay Elicitation(World Bank, Washington, DC, 2022-09) Kelse, Jack; McDermott, Kathryn; Sautmann, AnjaMultiple price lists are a convenient tool to elicit willingness to pay in surveys and experiments, but choice patterns such as “multiple switching” and “never switching” indicate high error rates. Existing measurement approaches often do not provide accurate standard errors and cannot correct for bias due to framing and order effects. This paper proposes to combine a randomization approach with a random-effects latent utility model to detect bias and account for error. Data from a choice experiment in South Africa shows that significant order effects exist which, if uncorrected, would lead to distorted conclusions about subjects’ preferences. Templates are provided to create a multiple price list survey instrument in SurveyCTO and analyze the resulting data using the proposed methods.Publication Overconfident: How Economic and Health Fault Lines Left the Middle East and North Africa Ill-Prepared to Face COVID-19(Washington, DC: World Bank, 2021-10-07) Fan, Rachel Yuting; Gatti, Roberta; Hatefi, Arian; Lederman, Daniel; Sax, Joseph Martin; Nguyen, Ha; Wood, Christina A.; Sautmann, AnjaThis report examines the region’s economic prospects in 2021, forecasting that the recovery will be both tenuous and uneven as per capita GDP level stays below pre-pandemic levels. COVID-19 was a stress-test for the region’s public health systems, which were already overwhelmed even before the pandemic. Indeed, a decade of lackluster economic reforms left a legacy of large public sectors and high public debt that effectively crowded out investments in social services such as public health. This edition points out that the region’s health systems were not only ill-prepared for the pandemic, but suffered from over-confidence, as authorities painted an overly optimistic picture in self-assessments of health system preparedness. Going forward, governments must improve data transparency for public health and undertake reforms to remedy historical underinvestment in public health systems.Publication Adaptive Experiments for Policy Choice: Phone Calls for Home Reading in Kenya(World Bank, Washington, DC, 2022-06) Esposito, Bruno; Sautmann, AnjaAdaptive sampling in experiments with multiple waves can improve learning for “policy choice problems” where the goal is to select the optimal intervention or treatment among several options. This paper uses a real-world policy choice problem to demonstrate the advantages of adaptive sampling and propose solutions to common issues in applying the method. The application is a test of six formats for automated calls to parents in Kenya that encourage reading with children at home. The adaptive ‘exploration sampling’ algorithm is used to efficiently identify the call with the highest rate of engagement. Simulations show that adaptive sampling increased the posterior probability of the chosen arm being optimal from 86 to 93 percent and more than halved the posterior expected regret. The paper discusses a range of implementation aspects, including how to decide about research design parameters such as the number of experimental waves.Publication The Effects of Community Health Worker Visits and Primary Care Subsidies on Health Behavior and Health Outcomes for Children in Urban Mali(World Bank, Washington, DC, 2022-03) Dean, Mark; Sautmann, AnjaSubsidized primary care and community health worker (CHW) visits are important demand side policies in the effort to achieve universal health care for children under five. Causal evidence on the effects of these policies, alone and in interaction, is still sparse. This paper reports the effects on diarrhea prevention, curative care, and incidence as well as anthropometrics for 1649 children from a randomized control trial in Bamako that cross-randomized CHW visits and access to free health care. CHW visits improve prevention and subsidies increase the use of curative care for acute illness, with some indication of positive interaction effects. There is no evidence of moral hazard, such as reduced preventive care among families receiving the subsidy. Although there are no significant improvements in malnutrition, diarrhea incidence is reduced by over 70% in the group that receives both subsidies and CHW. Positive effects are concentrated among children ages 0 to 2.Publication Does Patient Demand Contribute to the Overuse of Prescription Drugs?(World Bank, Washington, DC, 2020-11) Lopez, Carolina; Sautmann, Anja; Schaner, SimoneThis study conducted an experiment in Mali to test whether patients pressure doctors to prescribe medical treatment they do not necessarily need. The experiment varied patients’ information about a discount for antimalarial tablets and measured demand for both tablets and costlier antimalarial injections. The study finds evidence of patient-driven demand: informing patients about the discount, instead of letting doctors decide to share this information, increased discount use by 35 percent and overall malaria treatment by 10 percent. These marginal patients rarely had malaria, worsening the illness-treatment match. Providers did not use the information advantage to sell injections -- their use fell in both information conditions.Publication Subsidies, Information, and the Timing of Children’s Health Care in Mali(World Bank, Washington, DC, 2020-11) Brown, Samuel; Sautmann, Anja; Dean, MarkSustained progress in reducing child mortality requires better care for children who are acutely ill. This paper studies how health care subsidies and health workers providing information on symptoms affect the overuse and underuse of primary care, which depend not just on absolute levels of demand, but also on whether care is received when the child is actually sick. In a randomized controlled trial of 1,768 children in Mali, the study collected a unique panel of nine weeks of daily symptom and health care use data to study the impact of each policy on demand conditional on need for care, as defined by World Health Organization standards. Subsidies substantially increase care when it is medically indicated, while overuse remains rare. Health worker visits have no aggregate effect on demand, but they may help the youngest children take advantage of the subsidy.