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Health inputs and child mortality: Malaysia
1RAND, Santa Monica, CA 90407.
Insights
Prenatal medical care and institutional delivery significantly improve child survival. Ignoring self-selection in healthcare use underestimates these benefits, impacting child mortality rates.
Area of Science:
- Health Economics
- Demography
- Public Health
Background:
- Child mortality remains a significant global health challenge.
- The relationship between healthcare utilization and child survival is complex.
- Understanding healthcare demand and its impact on mortality is crucial for policy.
Purpose of the Study:
- To analyze the impact of healthcare utilization on fetal and child mortality.
- To model the demand for prenatal care and institutional delivery.
- To assess the effects of self-selection bias in healthcare use.
Main Methods:
- Developed a simultaneous model of fetal and postnatal mortality risks.
- Incorporated input demand equations for prenatal medical care and institutional delivery.
- Utilized retrospective data from Peninsular Malaysia (1950-1988).
Main Results:
- Prenatal care and institutional delivery show strong positive effects on child survival.
- These effects are underestimated when adverse self-selection is ignored.
- Healthcare effectiveness in Malaysia improved until 1980, then declined.
- Fetal survival influences child mortality, but ignoring this introduces mild biases.
- Young mothers' higher child mortality is partly due to lower healthcare utilization.
Conclusions:
- Healthcare utilization, particularly prenatal care and institutional delivery, is vital for reducing child mortality.
- Accounting for self-selection in healthcare use provides more accurate impact estimates.
- Trends in healthcare effectiveness highlight the need for continuous monitoring and policy adjustments.
Abstract:
This paper is concerned with the relationship between child mortality and the use of health care. We develop a simultaneous model of fetal and postnatal mortality risks and input demand equations for prenatal medical care and institutional delivery. This model is applied to retrospective data from Peninsular Malaysia covering 1950-1988. The results show that prenatal medical care and institutional delivery have strong beneficial effects on child survival probabilities, and that these effects are substantially underestimated when adverse self-selection among users of health care is ignored. The effectiveness of prenatal health care in Malaysia improved until 1980, and then deteriorated. We find that the risk of infant and child mortality is not independent of fetal survival, but show that ignoring selective fetal survival introduces only mild biases in infant and child mortality estimation. Higher infant and child mortality rates among young mothers are partly explained by their lower likelihood of purchasing health care.