FREE DISTRIBUTION OR COST-SHARING? EVIDENCE FROM A RANDOMIZED MALARIA PREVENTION EXPERIMENT
FREE DISTRIBUTION OR COST-SHARING? EVIDENCE FROM A RANDOMIZED MALARIA PREVENTION EXPERIMENT
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DOI：
10.1162/qjec.2010.125.1.1
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发表时间：
2010-02-01
影响因子：
13.7
通讯作者：
Dupas, Pascaline
中科院分区：
文献类型：
--
作者：
Cohen, Jessica;Dupas, Pascaline
人们常常认为，为了避免在那些不使用或不需要这种产品的人身上浪费资源，分摊成本——对一种健康产品收取补贴的积极价格——是必要的。我们通过在肯尼亚进行的一项实地试验探讨了这一论点，在该试验中，我们随机确定了产前诊所向孕妇出售长效抗疟驱虫蚊帐（ITNs）的价格。我们没有发现任何证据表明费用分摊减少了那些不使用该产品的人的浪费：获得免费ITNs的妇女使用它们的可能性并不低于支付补贴价格的妇女。我们也没有发现任何证据表明，费用分摊会导致更需要蚊帐的妇女被选择：就测量的贫血（疟疾的一个重要指标）而言，那些支付更高价格的妇女似乎并不比该地区的平均产前客户更生病。然而，费用分摊确实大大抑制了需求。我们发现，当ITNs的价格从零增加到0.60美元（即从100%补贴到90%补贴）时，吸收率下降了60个百分点，这个价格仍然比肯尼亚目前向孕妇出售ITNs的价格低0.15美元。我们将我们的估计合并到一个关于蚊帐价格对儿童死亡率影响的成本效益分析中，该分析包含了使用蚊帐的私人和社会回报。总的来说，我们的研究结果表明，与成本分摊计划相比，免费分发ITNs可以挽救更多的生命，并且考虑到ITNs广泛使用带来的巨大正外部性，可能会以更低的成本挽救更多的生命。
It is often argued that cost-sharing-charging a subsidized, positive price-for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument through a field experiment in Kenya, in which we randomized the price at which prenatal clinics could sell long-lasting antimalarial insecticide-treated bed nets (ITNs) to pregnant women. We find no evidence that cost-sharing reduces wastage on those who will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that cost-sharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the average prenatal client in the area in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by sixty percentage points when the price of ITNs increases from zero to $0.60 (i.e., from 100% to 90% subsidy), a price still $0.15 below the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of the impact of ITN prices on child mortality that incorporates both private and social returns to ITN usage. Overall, our results suggest that free distribution of ITNs could save many more lives than cost-sharing programs have achieved so far, and, given the large positive externality associated with widespread usage of ITNs, would likely do so at a lesser cost per life saved.