Date of Award

Summer 8-22-2018

Level of Access Assigned by Author

Open-Access Thesis

Degree Name

Master of Science (MS)

Department

Economics

Advisor

Angela Daley

Second Committee Member

Ewa Kleczyk

Third Committee Member

Mario Teisl

Abstract

Through private and public efforts, there has been considerable improvement in the health and healthcare sector in Nepal. However, the healthcare system in Nepal faces challenges such as limited access and lack of quality healthcare. Although there have been recent efforts to introduce universal healthcare coverage, there is limited evidence on existing systems to properly formulate a policy. To provide a wholistic review of the Nepali health system, we assess both public and private sectors. In 2005, Nepal introduced a financial incentive, called the Safe Delivery Incentive Program, to increase the use of maternity care with the goal of reducing maternal and neonatal mortality. The program included a cash transfer to help with transportation costs, free delivery for mothers in certain districts and an incentive for healthcare providers to participate in the delivery. In the first paper, we use microdata from the Demographic and Health Surveys (2001 to 2008) and a difference-in-differences model to estimate the effect of free delivery, which was only implemented for mothers in 25 Nepali districts with the lowest Human Development Index. We measure five outcomes: neonatal mortality; prenatal care; prenatal care by doctor; prenatal care by nurse/midwife and immunization against neonatal tetanus. The sample consists of 5,317 live births between the years of 2001-2008. We find that women are more likely to get prenatal care from a doctor, nurse or midwife and immunization against neonatal tetanus if they reside in districts with free delivery care. Further, neonates born to mothers in the treatment district are more likely to survive, which may have occurred due to increased prenatal care and tetanus vaccines. We provide new evidence that the program did prenatal care, which is contingent on wealth quintile, ethnicity and education. In the second paper, we address the limited empirical evidence on the relationship between management and performance of private hospitals in Nepal, with emphasis on differences by performance indicator, patient type and analytical approach. We use de-identified inpatient data to assess the relationship between hospital management and performance. We estimate Pabon Lasso and regression models for native-born and foreign-born patients, and for the full sample of patients. Using a Pabon Lasso model, we assess relationship between hospital management and: bed occupancy rate; bed turnover rate; and average length of stay. To complement the Pabon Lasso model, we use a regression analysis to assess the relationship between hospital management and length of stay in a multivariate framework. Our results indicate that separation between the Chief Executive Officer (CEO) and board may promote better performance (except the Pabon Lasso model favors CEO duality for average length of stay among native-born patients). However, results vary by performance indicator, patient type and analytical approach. We provide new evidence on the relationship between management and performance of private hospitals in a developing context. However, when it comes to evaluating management strategies, there are important differences by outcome measure, patient type (i.e. native-born versus foreign-born) and analytical approach.

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