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CINCH - Health Economics Research Center

Virtual Essen Health Economics Seminar


On Monday, June 22 2020, 16:00 - 17:30, Maximilian Lückemann (IHE Hannover) will present:

Does Competition matter? – Early empirical Evidence on the quality of ambulatory Care

Due to a rapidly aging population in Germany, ambulatory care facilities have experienced increasing demand for outpatient care. Therefore, we observed numerous of newly established facilities in the market. At the same time, we are aware of the lack of qualified nursing staff who can provide good quality. In this research, we examine the effect of increasing outpatient care competition on care quality, based on the quality disclosure of the MRB in Germany. Considering the latest critique on the transparency reports, we created new quality indices and found small but significant quality detoriating effects observing data from 2011 to 2019.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.

Virtual Essen Health Economics Seminar


On Monday, June 15 2020, 16:00 - 17:30, George MacKerron (University of Sussex) will present:

Mappiness: dynamics and loss aversion in the wellbeing of football supporters

By joining Mappiness, which is a large panel of momentary happiness data, to detailed information on British football matches between 2010 and 2017, we are able to identify football supporters and the teams they support. After conditioning on expected results for each match using bookmakers’ odds, match events and match results represent exogenous shocks to these supporters. We show how these events and results affect supporters’ reported momentary happiness, and provide some preliminary, novel evidence of loss aversion.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.

Virtual Essen Health Economics Seminar


On Monday, June 8 2020, 16:00 - 17:30, Lucia Fiestas Navarrete (Bocconi University) will present:

The Speculum of marital age: How early marriage impacts women’s use of opportunistic cervical and breast screening in India


The consequences of women’s social status on health are widely discussed in the literature, yet partly owing to the difficulty in measuring the complex phenomenon of disempowerment, few have offered insight into how the conditions of social life affect women’s health utilization. Our main objective is to investigate the effect of female empowerment, in the form of marital age, on women’s use of cervical and breast screening in India, while exploring the channels that mediate and moderate the relationship.


We linked data from a sample of 15,903 ever-married women (15-49 years) who participated in the National Family Health Survey in 2015-16 with district-level data from the Indian Ministry of Health on per capita health facility supply. Drawing on Lauver’s theory of care-seeking behaviour, we incorporate women’s health insurance status into the analysis as a critical factor facilitating the external conditions that enable women to seek care. Our empirical strategy relies on a twofold instrumental variable approach seeking to generate quasi-random sources of variation in marital age and insurance participation. Specifically, we instrument age of first union by age of first menstruation and insurance status by cluster insurance rate in order to isolate their causal influence on women’s health utilization. Using structural equation modelling, we test (i) whether financial self-efficacy mediates the relationship between marital age and opportunistic screening and (ii) to what extent the district-level per capita supply of community health centres (CHCs) moderates the strength of the mediating channel.


The prevalence of ever having cervical and breast screening is 23 and 9 percent, respectively. We show that with every additional year that marriage is postponed, the probability of a woman ever having a cervical exam significantly increases by 7.9 percentage points and that of having a breast exam by 5.1. We find that higher marital age is associated with improvements in financial self-efficacy, which in turn, positively influence women’s use of cervical and breast screening. This is an important finding as it reveals financial self-efficacy to be consistent with a ‘second-stage’ form of empowerment resulting from marriage postponement. We also show that the indirect effect of marital age on cervical screening mediated through financial self-efficacy is positive and significant for any value of district supply greater than 3.6 CHCs per million inhabitants. This points to the critical burden that a poor supply context may have on women’s health utilization despite the relative improvements in autonomy associated with marital age.


Our findings suggest that losses in female empowerment attributed to early marriage partly explain Indian women’s low cervical and breast screening participation. Interventions aiming to address the uniquely high prevalence of women’s cancers in India would be wise to reflect on the health utilization consequences that can be attributed to socio-cultural practices exacerbating female disempowerment. Enforcing legal protections against underaged marriage is an actionable arena where both social and health agendas may converge in the interest of women – and good public policy.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.