Essays in Health Economics

This dissertation consists of three essays on empirical issues in health economics using evidence from sub-Saharan Africa (SSA). The first essay addresses the debate about whether health products, like insecticide-treated bednets (ITNs), should be free or have a positive price to maximize ownership and use. I use evidence from an experiment in Madagascar where price was randomized at the village level. The results show that higher prices significantly reduce demand and use of ITNs. In addition, households more at risk of malaria are riot more likely to own or use an ITN and households that received a free ITN are not more likely to waste them. The findings suggest that free or small nominal prices will maximize ITN ownership and effective coverage. The second essay evaluates the long-term effects of rainfall during the in-utero period on maternal mortality in SSA. I examine this hypothesis by using data from SSA on rainfall during the period when a woman was in-utero and relate these data to maternal survival later in life. The results show that a positive rainfall shock in-utero significantly improves maternal survival. I find evidence that this effect may be mediated through an effect on: 1) being anemic (hiring adulthood, which influences the risk of hemorrhaging; 2) access to skilled birth attendants at delivery through an effect on education and income. If better outcomes associated with positive rainfall shocks could be achieved, maternal mortality ratios would be 16% closer to the Millennium Development Goals (MDG) for maternal health. The third essay examines the link between in-utero, early-life, and childhood rainfall on women's educational attainment in SSA. The results show that rainfall during the in-utero period and during ages 1-3 is predictive of women's education. There is no evidence of an effect on women's economic outcomes, but there is evidence of an effect on the educational outcomes of women's husbands. In the case of in-utero rainfall, there is also an effect on women's decision-making in the household. Overall, the effect sizes are relatively small, meaning that better in-utero or early-life conditions will not significantly improve educational attainment in SSA.