Sautmann, Anja

Profile Picture
Author Name Variants
Fields of Specialization
Health Care Demand, Economic Preferences, Experimental Methods, West Africa
Externally Hosted Work
Contact Information
Last updated January 31, 2023
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.

Publication Search Results

Now showing 1 - 8 of 8
  • Thumbnail Image
    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) Gatti, Roberta ; Lederman, Daniel ; Fan, Rachel Yuting ; Hatefi, Arian ; Nguyen, Ha ; Sautmann, Anja ; Sax, Joseph Martin ; Wood, Christina A.
    This 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.
  • Thumbnail Image
    Does Patient Demand Contribute to the Overuse of Prescription Drugs?
    (World Bank, Washington, DC, 2020-11) Lopez, Carolina ; Sautmann, Anja ; Schaner, Simone
    This 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.
  • Thumbnail Image
    Multiple Price Lists for Willingness to Pay Elicitation
    (World Bank, Washington, DC, 2022-09) Kelse, Jack ; McDermott, Kathryn ; Sautmann, Anja
    Multiple 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.
  • Thumbnail Image
    Gender Differences in Children's Antibiotic Use and Adherence
    (World Bank, Washington, DC, 2021-02) Blandhol, Christine ; Sautmann, Anja
    Using in-home health records for 1,763 children in Mali, this paper examines gender differences in the uptake and duration of treatment with antibiotics. The detailed data provide a window into parents’ day-to-day decisions while accounting for symptoms. There are no gender differences in starting treatment, but boys are over 10 percentage points more likely to complete a course of antibiotics than girls. This difference is driven by families with an educated household head. An explanation may be that (male) household heads are less involved in caring for girls, so that benefits from education that lead to better care accrue overproportionally to boys.
  • Thumbnail Image
    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, Ellen
    In 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.
  • Thumbnail Image
    Subsidies, Information, and the Timing of Children’s Health Care in Mali
    (World Bank, Washington, DC, 2020-11) Sautmann, Anja ; Brown, Samuel ; Dean, Mark
    Sustained 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.
  • Thumbnail Image
    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, Anja
    Subsidized 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.
  • Thumbnail Image
    Adaptive Experiments for Policy Choice: Phone Calls for Home Reading in Kenya
    (World Bank, Washington, DC, 2022-06) Esposito, Bruno ; Sautmann, Anja
    Adaptive 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.