Research
Working papers
Welfare Gain from Using Diagnosis Contingent Incentive Contracts to Improve Malaria Treatment
We examine a novel diagnosis contingent incentive contract designed to improve the treatment of malaria. The contract provides incentives to use rapid diagnostic tests (RDTs) to diagnose patient malaria status combined with incentives to treat with antimalarial drugs (ACTs) if the patient tests positive but not if they test negative. Using data from a cluster randomized field experiment with 140 pharmacies in Kenya, we find that both patient subsidies and provider incentives significantly increased RDT testing uptake and reduced the purchase of unnecesary ACTs by those whose test negative. Patient incentives operate through lower prices, whereas provider incentives work through providers giving better information and advice. Using a model of patient choice, we estimate that diagnosis-contingent contracts increase social welfare substantially relative to program costs, where the primary gain in welfare comes from a reduc- tion in the use of ACTs from patients who test negative and therefore do not need treatment. Finally, we use the experiment to estimate a structural model that allows us to explore counter- factual contract designs. We find that the biggest welfare gains per unit of program cost come from contracts that load all of the incentives in reducing the price of treatment contingent on testing positive for malaria due to biased patient beliefs. The optimal contract delivers 4 times the welfare gains of a policy that simply offers free testing while keeping expected costs to the planner below the retail price of tests.
Trial pre-registration:AEARegistry
Current draft:Click here
Ongoing projects
Provider Agency and Health Technology Adoption: How Financial Incentives Impact the Uptake of a New Contraceptive
We investigate how targeted subsidies for long-acting injectable contraception and provider incentives impact initial uptake, pricing and stocking decisions for contraceptive products in local markets, sales, and user health outcomes. Following prior work on the effectiveness of subsidies to promote the adoption of new technologies and experience goods, we aim to test if subsidies lead to sustained adoption of injectable contraception as well as to study possible mechanisms for continued usage (or lack of) such as learning, price anchoring, and information effects. We condcuted a market-level cluster randomized controlled trial in 140 pharmacies in Kenya to answer these questions. Patient subsidies and pharmacist incentives will be cross-randomized and compared against the status quo to evaluate their effectiveness in promoting sustained adoption. Data collection complete. Collaborators are Paul Gertler and Carlos Paramo.
Trial pre-registration:AEARegistry
Caregiver Decision-making and Quality of Care for Childhood Fevers in Pharmacy Settings
Febrile illness is a leading cause of death and serious illness for millions of children across sub-Saharan Africa, despite the availability of diagnostics and appropriate medications. Unfortunately, many fevers are not treated appropriately due to incorrect or no diagnosis, and use of inappropriate medications. Inappropriate treatment has uncertain health and economic costs to individuals as well as at a population level. This study will provide visibility on this issue through an analysis of care-seeking behavior, diagnosis/treatment decisions, and illness episode outcomes in children with fevers who seek care in Kenyan pharmacies. This pilot will contribute towards a better understanding of the causes and consequences of childhood fevers and associated care-seeking trajectories, which is crucial for effective management of childhood illness in sub-Saharan Africa. Pilot study data collection complete, manuscript writing in progress.
Extreme weather, parental investments, and child health in Madagascar
Using panel microdata on household inputs and child health outcomes and high-resolution gridded climate data from Madagascar, we investigate how weather-induced income shocks affect parental investments and child nutrition and cognition outcomes.
Publications
For list of publications, see here. Please reach out if you are unable to access an article - I am happy to send you an ungated version.
Welfare Gain from Using Diagnosis Contingent Incentive Contracts to Improve Malaria Treatment
We examine a novel diagnosis contingent incentive contract designed to improve the treatment of malaria. The contract provides incentives to use rapid diagnostic tests (RDTs) to diagnose patient malaria status combined with incentives to treat with antimalarial drugs (ACTs) if the patient tests positive but not if they test negative. Using data from a cluster randomized field experiment with 140 pharmacies in Kenya, we find that both patient subsidies and provider incentives significantly increased RDT testing uptake and reduced the purchase of unnecesary ACTs by those whose test negative. Patient incentives operate through lower prices, whereas provider incentives work through providers giving better information and advice. Using a model of patient choice, we estimate that diagnosis-contingent contracts increase social welfare substantially relative to program costs, where the primary gain in welfare comes from a reduc- tion in the use of ACTs from patients who test negative and therefore do not need treatment. Finally, we use the experiment to estimate a structural model that allows us to explore counter- factual contract designs. We find that the biggest welfare gains per unit of program cost come from contracts that load all of the incentives in reducing the price of treatment contingent on testing positive for malaria due to biased patient beliefs. The optimal contract delivers 4 times the welfare gains of a policy that simply offers free testing while keeping expected costs to the planner below the retail price of tests.
Trial pre-registration:
Ongoing projects
Provider Agency and Health Technology Adoption: How Financial Incentives Impact the Uptake of a New Contraceptive
We investigate how targeted subsidies for long-acting injectable contraception and provider incentives impact initial uptake, pricing and stocking decisions for contraceptive products in local markets, sales, and user health outcomes. Following prior work on the effectiveness of subsidies to promote the adoption of new technologies and experience goods, we aim to test if subsidies lead to sustained adoption of injectable contraception as well as to study possible mechanisms for continued usage (or lack of) such as learning, price anchoring, and information effects. We condcuted a market-level cluster randomized controlled trial in 140 pharmacies in Kenya to answer these questions. Patient subsidies and pharmacist incentives will be cross-randomized and compared against the status quo to evaluate their effectiveness in promoting sustained adoption. Data collection complete. Collaborators are Paul Gertler and Carlos Paramo.
Trial pre-registration:
Caregiver Decision-making and Quality of Care for Childhood Fevers in Pharmacy Settings
Febrile illness is a leading cause of death and serious illness for millions of children across sub-Saharan Africa, despite the availability of diagnostics and appropriate medications. Unfortunately, many fevers are not treated appropriately due to incorrect or no diagnosis, and use of inappropriate medications. Inappropriate treatment has uncertain health and economic costs to individuals as well as at a population level. This study will provide visibility on this issue through an analysis of care-seeking behavior, diagnosis/treatment decisions, and illness episode outcomes in children with fevers who seek care in Kenyan pharmacies. This pilot will contribute towards a better understanding of the causes and consequences of childhood fevers and associated care-seeking trajectories, which is crucial for effective management of childhood illness in sub-Saharan Africa. Pilot study data collection complete, manuscript writing in progress.
Extreme weather, parental investments, and child health in Madagascar
Using panel microdata on household inputs and child health outcomes and high-resolution gridded climate data from Madagascar, we investigate how weather-induced income shocks affect parental investments and child nutrition and cognition outcomes.
Publications
For list of publications, see here. Please reach out if you are unable to access an article - I am happy to send you an ungated version.