Publication: Europe and Central Asia's Great Post-Communist Social Health Insurance Experiment : Impacts on Health Sector and Labor Market Outcomes
The post-communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs a regression-based generalization of the difference-in-differences method and instrumental variables on panel data from 28 countries for the period 1990-2004. The authors find that, controlling for any concurrent provider payment reforms, adoption of social health insurance increased national health spending and hospital activity rates, but did not lead to better health outcomes. The authors also find that adoption of social health insurance reduced employment in the economy as a whole and increased unemployment, although it did not apparently increase the size of the informal economy.
Link to Data Set
“Wagstaff, Adam; Moreno-Serra, Rodrigo. 2007. Europe and Central Asia's Great Post-Communist Social Health Insurance Experiment : Impacts on Health Sector and Labor Market Outcomes. Policy Research Working Paper; No. 4371. © World Bank, Washington, DC. http://hdl.handle.net/10986/7382 License: CC BY 3.0 IGO.”
Other publications in this report series
PublicationCorruption as a Push and Pull Factor of Migration Flows: Evidence from European Countries(World Bank, Washington, DC, 2023-09-14)Conclusive evidence on the relationship between corruption and migration has remained scant in the literature to date. Using data from 2008 to 2018 on bilateral migration flows across European Union and European Free Trade Association countries and four measures of corruption, this paper shows that corruption acts as both a push factor and a pull factor for migration patterns. Based on a gravity model, a one-unit increase in the corruption level in the origin country is associated with a 11 percent increase in out-migration. The same one-unit increase in the destination country is associated with a 10 percent decline in in-migration.
PublicationRebel with a Cause: Effects of a Gender Norms Intervention for Adolescents in Somalia(World Bank, Washington, DC, 2023-09-15)Gender inequality and restrictive norms are often reinforced and internalized during adolescence, influencing pivotal life choices. This paper presents results from a randomly-assigned gender norms intervention for young adolescents in Somalia that led to greater support for gender equality in reported attitudes among both girls and boys. In a novel lab-in-the-field experiment designed to observe social group dynamics, treated adolescents were also found to be less likely to succumb to peer pressure to conform when stating their gender attitudes in public. Perceptions of gender norms appears to shift for boys, leading to a greater public expression of gender egalitarian ideals. Furthermore, the findings show improved adolescent mental health, increased caring behavior towards siblings of the opposite sex, and a higher likelihood of involvement in household chores by boys. A complementary gender norms intervention for parents had limited marginal impact on the attitudes and behaviors of adolescents. The results suggest that gender norms interventions can be effective in influencing the attitudes and public discourse around gender equality, even in early adolescence.
PublicationPolicy Uncertainty and Aggregate Fluctuations: Evidence from Emerging and Developed Economies(World Bank, Washington, DC, 2023-09-12)This paper identifies two types of policy uncertainty measures–government spending and real interest rates–and their impact on macroeconomic activity in 54 advanced, emerging, and developing economies. Policy uncertainty is defined as the inability to predict policy moves, that is, the conditional volatility of policy shocks. This is achieved in a panel vector autoregression model which allows, but does not require, the stochastic volatility of identified shocks to have direct and dynamic effects on macroeconomic outcomes. It shows that fiscal and monetary policy uncertainty are damaging to economic activity and act like negative supply shocks: raising prices while lowering output, investment and consumption. A one standard deviation government spending uncertainty shock decreases real gross domestic product (GDP) by a cumulative 1.0 percentage point and marginally increases inflation after two years. A one standard deviation real interest rate uncertainty shock lowers real GDP by a cumulative 1.3 percentage points after two years but raises inflation by 0.5 percentage point.
PublicationIdentifying Skills Needs in Vietnam: The Survey of Detailed Skills(World Bank, Washington, DC, 2023-09-12)This paper describes a new survey designed to collect comprehensive and granular information about required skills and tasks for detailed occupations in Vietnam. The Survey of Detailed Skills asks workers in Vietnam about their skills and tasks for a set of 30 occupations that are in demand or of strategic importance for economic growth. In doing so, the survey generates practical, detailed information at the occupation level that policy makers and practitioners can use to inform their efforts to build skills in Vietnam. The Survey of Detailed Skills makes several contributions. Most existing efforts to profile occupational skills and tasks in developing countries draw on data from other countries, most frequently the Occupational Information Network (O*NET) in the United States. However, recent research has shown that translating these data across countries via occupational crosswalks yields inaccurate results. The Survey of Detailed Skills is among the first surveys to collect detailed O*NET-type information at the detailed occupational level in a developing country setting. The collection of information about detailed skills means that these skills can be flexibly grouped into different categories (for example, socioemotional skills, digital skills, routine skills, and interpersonal skills) as needed. The use of a consistent scale anchored to the time spent using or performing a skill or task creates clarity for respondents while also yielding a measure of skill and task importance that is easily interpreted. The Survey of Detailed Skills requires outlays on administering the survey, and inclusion of all occupations in Vietnam with regular updating would require ongoing investment.
PublicationSavings Facilitation or Capital Injection?: Impacts and Spillovers of Livelihood Interventions in Post-Conflict Côte d’Ivoire(World Bank, Washington, DC, 2023-09-12)Policy makers grapple with the optimal design of multidimensional strategies to improve poor households’ livelihoods. To address financial constraints, are capital injections needed, or is savings mobilization sufficient This paper tests the direct effects and local spillovers of three instruments to relax financial constraints, each combined with micro-entrepreneurship training. “Cash grants” and “cash grants with repayment” directly inject capital, while “village savings and loan associations” (VSLAs) promote more efficient group saving. The randomized controlled trial took place in western regions of Côte d’Ivoire that were affected by a post-electoral crisis in 2011 and an earlier conflict. The interventions had differential effects on the dynamics of savings and productive asset accumulation. The cash grant modalities generated investments in startup capital, although nearly 30 percent of the grant was saved. In contrast, village savings and loan associations did not increase total savings but gradually induced investments, so that productive assets caught up with cash grant recipients after 15 months. Positive local spillovers on savings and independent activities were also observed. Yet, investments in independent activities were not sufficient to increase profits, possibly because they were limited due to high precautionary saving motives in the post-conflict study setting.