Publications
This paper examines the distributional effects of monetary policy in 12 OECD economies between 1920 and 2016. We exploit the implications of the macroeconomic policy trilemma with an external instrument approach to analyze how top income shares respond to monetary policy shocks. The results indicate that monetary tightening strongly decreases the share of national income held by the top 1 percent and vice versa for a monetary expansion, irrespective of the position of the economy. This effect (i) holds for the top percentile and the ultrarich (top 0.1 percent and 0.01 percent income shares), while (ii) it does not necessarily induce a decrease in income inequality when considering the entire income distribution. Our findings also suggest that the effect of monetary policy on top income shares is likely to be channeled via real asset returns.
This paper evaluates how three different international accreditations for business schools (AACSB, EQUIS and AMBA) affect student preferences, expressed via enrollment decisions. Focusing on the French context, we build a relative preference indicator to compare schools using data collected by the central clearinghouse that allocates students to schools. We observe that all three accreditations positively and significantly influence students, but that the impact of the AACSB accreditation is larger than the other two accreditations. Having an AACSB accreditation is equivalent to moving up four places in rankings by L’étudiant magazine, whereas the impact of having EQUIS or AMBA is similar to moving up two places. We also find a sizeable “triple crown” effect, meaning that the three accreditations tend to complement each other. Our results are robust to different ways of assessing potential self-selection into accreditation.
Limited access to information is one of the main health insurance market imperfections in developing countries. Differential access to information may determine individuals’ awareness of health insurance schemes, thereby influencing their probability of enrollment. Relying on primary data collected in 2019–2020 in rural Senegal, we estimate the uptake of community-based health insurance using a Heckman-type model to correct for awareness-based sample selection bias. Besides showing that health insurance awareness is a precondition for effective enrollment in community-based health insurance schemes, we also bring new evidence on the roles which geographic factors and individual risk preference play in health insurance uptake by rural dwellers. We show that geographic distance prevents individuals from accessing information on health insurance schemes, and discourage those who are informed from enrolling, because of the additional distance they must travel to benefit from covered healthcare services. Results also show that individual risk preference influences health insurance uptake, but only when information barriers are taken into account. Overall, our results could help decision-makers better shape the universal health coverage roadmap, as policies to improve health insurance awareness differ substantially from policies to improve the features of health insurance schemes.
This paper accounts simply for the link between higher education and the productive economy through educated workers. We study a model of vertical successive monopolies where students/workers acquire qualification from a University then “sell” skilled labor to a monopoly which itself sells its final product to consumers, linking through quality the education sector to the labor and output markets. We determine the optimal share the State should keep in the University to compensate for the market imperfections, while taking into account the inefficiencies of public management. The resulting partially privatized University fixes the tuition fees so as to maximize a weighted sum of profits and social welfare. We derive the optimal public share under the hypothesis that the State may subsidize the tuition fees/University losses, then under the constraint that the University should make a nonnegative profit. We prove that in both cases, the State should keep a substantial share (higher under the first hypothesis) in the University, unless public management is too inefficient in which case the University's management should be completely private.
Cette étude a pour objectif d’évaluer différents modes de financement de la couverture santé universelle au Sénégal. La méthode utilisée, la micro-simulation, permet d’examiner l’impact de différents scenarii sur les consommations des ménages ainsi que sur les dépenses publiques. Les résultats montrent que la généralisation d’une assurance-maladie à l’ensemble de la population, associée à une réduction des coûts directs des soins, augmenterait les consommations de soins des Sénégalais, améliorant donc leur accès aux services de santé. Néanmoins, une telle généralisation serait coûteuse pour les finances publiques. Pour limiter les coûts supportés par le gouvernement, l’augmentation du taux d’imposition sur la consommation et de la prime de contribution à l’assurance-maladie serait utile et permettrait de ramener les finances publiques à l’équilibre.
Explorant les riches données longitudinales fournies par l’Observatoire de santé et de population de Niakhar, cette étude examine les effets des migrations sur la mortalité infanto-juvénile dans les familles rurales restées au village. Les migrations, en particulier de courte durée, sont associées de manière positive aux chances de survie des enfants de moins de cinq ans au sein du ménage. On constate également que les déplacements de courte durée des femmes d’âge actif ont plus d’incidences sur la mortalité des enfants que ceux de leurs homologues masculins. De surcroît, des effets croisés sont identifiés entre ménages de la même concession, ce qui est conforme à l’idée que les familles rurales africaines partagent les gains de l’émigration avec une communauté étendue de voisins. Enfin, l’effet des migrations maternelles de courte durée sur la survie des enfants de moins de cinq ans demeure globalement positif, mais nettement plus modeste. L’émigration de la mère, en particulier pendant la grossesse, semble améliorer la probabilité de survie des enfants juste après la naissance, mais celle-ci tend à diminuer après l’âge d’un an et lorsque la mère est absente.
This paper analyzes the effect of a pay-as-you-go pension system on the evolution of capital and pollution, and on the efficiency of an environmental versus health policy. In an overlapping generations model, we introduce endogenous longevity that depends on pollution and health expenditures. Global dynamics may display multiple balanced growth paths (BGPs). We show that by discouraging savings, a policy that promotes the pension system enlarges the environmental poverty trap. More surprisingly, the environmental policy has contrasting effects according to the significance of the pension system. If it has a small size, a more environmentally-friendly policy enlarges the environmental poverty trap and leads to a rise in capital over pollution at the highest stationary equilibrium. In contrast, in economies where intergenerational solidarity is well developed, capital over pollution decreases at the highest BGP. In such a case, the environmental policy does not necessarily lead to a better longevity and growth.
We study physicians’ incentives to use personalised medicine techniques, replicating the physician’s trade-offs under the option of personalised medicine information. In a laboratory experiment conducted in two French Universities, prospective physicians played a real-effort game. We vary both the information structure (free access versus paid access to personalised medicine information) and the payment scheme (pay-for-performance (P4P), capitation (CAP) and fee-for-service (FFS)), implementing a within-subject design. Our results are threefold: (i) Compared to FFS and CAP, the P4P scheme strongly and positively impacts the decision to adopt personalised medicine. (ii) Although expected to dominate the other schemes, P4P is not always efficient in transforming free access to personalised medicine into higher quality of care. (iii) When it has to be paid for and after controlling for self-selection, personalised medicine is positively associated with quality, suggesting that subjects tend to make better use of information that comes at a cost. We find this effect to be stronger for males than for females prospective physicians. Quantification of our results however suggests that this positive impact is not strong enough to justify generalising the payment for personalised medicine access. Finally, we develop a theoretical model that includes in its set-up a commitment device component, which is the mechanism that we inferred from the data of the experiment. Our model replicates the principal results of the experiment, reinforcing the interpretation that the higher quality provided by subjects who bought personalised medicine can be interpreted as a commitment device effect.
Background
Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness.
Methods and findings
We reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41–1.99], p < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16–1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20–1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05–2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03–1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response.
Conclusions
Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of ‘ending AIDS by 2030’, while simultaneously supporting progress towards universal health coverage.
