A new working paper has been added to the CINCH working paper series: “Subjective and objective quality reporting and choice of hospital: Evidence from maternal care services in Germany” by Daniel Avdic, Tugba Büyükdurmus, Giuseppe Moscelli, Adam Pilny, and Ieva Sriubaite.
We study patient choice of healthcare provider based on both objective and subjective quality measures in the context of maternal care hospital services in Germany. Objective measures are obtained from publicly reported clinical indicators, while subjective measures are based on satisfaction scores from a large and nationwide patient survey. We merge both quality metrics to detailed hospital discharge records and quantify the additional distance expectant mothers are willing to travel to give birth in maternity clinics with higher reported quality. Our results reveal that patients are on average willing to travel between 0.7-4.2 additional kilometers for a one standard deviation increase in reported quality. Furthermore, patients respond independently to both objective and subjective quality measures, suggesting that satisfaction scores may constitute important complements to clinical indicators when choosing healthcare provider.
A new working paper has been added to the CINCH working paper series: “Utilisation of personal care services in Scotland: the influence of unpaid carers” by Elizabeth Lemmon.
Unpaid carers may have an influence on the formal care utilisation of the cared for. Whether this influence is positive or negative will have important implications for the costs of formal care provision. The relationship between unpaid and formal care is of particular importance in Scotland, where personal care is provided for free by Local Authorities, to individuals aged 65+. The existing evidence on the impact of unpaid care on formal care utilisation is extremely mixed, and there is currently no evidence for Scotland. This paper is the first to investigate how the presence of an unpaid carer influences personal care use by those aged 65+ in Scotland, using a unique administrative dataset not previously used in research. Specifically, it uses the Scottish Social Care Survey (SCS) from 2015 and 2016 and compares Ordinary Least Squares (OLS), Generalised Linear Models (GLM), and Two-Part Models (2PM). The results suggest that unpaid care complements personal care services and this finding is robust to a number of sensitivity analyses. This finding may imply that incentivising unpaid care could increase formal care costs, and at the same time it points to the potential for unmet need of those who do not have an unpaid carer. Due to the limitations of the data, future research is necessary.
A new working paper has been added to the CINCH working paper series: “The Educational and Fertility Effects of Sibling Deaths” by Dhanushka Thamarapani, Marc Rockmore, and Willa Friedman.
An emerging literature finds that childhood exposure to adverse events determines adult outcomes and behavior. We extend this research to understand the influence of witnessing a sibling death as a child on subsequent educational and fertility outcomes in Indonesia. Using panel data and a sibling fixed effects model, we identify this relationship based on variation in the age of surviving children within the same family. Our findings strongly support the importance and persistence of adverse childhood experiences. In particular, for surviving sisters, witnessing a sibling death reduces the years of completed education and the likelihood of completing secondary schooling. The effect on surviving brothers is more muted. A potential channel for this result is that women respond by changing their fertility behavior. While surviving the death of a sibling has little effect on desired fertility levels, we find evidence that surviving sisters start a family about 3-4 years earlier. This suggests that interventions targeted at early-life outcomes may have important ripple effects and that the full impact of health interventions may not be visible until decades afterwards.