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Essays on inequalities in health and health care during economic recessions

Kyriopoulos, Ilias-Ioannis (2019) Essays on inequalities in health and health care during economic recessions. PhD thesis, London School of Economics and Political Science.

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During the past decade, Greece faced an unprecedented economic crisis and signed an economic adjustment programme (EAP) that brought about changes and reforms to the Greek health system. Comprised of three empirical studies, this thesis focuses on the impact of the Greek crisis on the health sector, with a particular interest in the responses to and implications of the crisis across socioeconomic groups. The first paper studies how household spending behaviour and responses towards health care have changed across socioeconomic groups in the face of an economic shock and the relevant health policy measures. Our analysis suggests that the income elasticity of household health expenditure (HHE) is below unity and exhibits a significant increase after the introduction of the EAP. Thus, households exhibit greater health care consumption responses to changes in their income. Contrary to high socioeconomic status (SES) groups, lower SES households did not become more sensitive to income changes in the post-EAP period, and have been more “protective” about their health care consumption. Focusing on the older population, the second study concentrates on the potential changes and implications in terms of financial protection against health payments during the Greek recession. We find that the headcount and overshoot of catastrophic health expenditure (CHE) increased during the crisis, with low-income and households with multimorbid patients being disproportionately affected. Prior to the crisis, CHE was mainly due to inpatient and nursing care. During the recession, however, the contribution of pharmaceutical spending to CHE substantially increased. Our analysis also reveals that there are widening inequalities in the risk of CHE across socioeconomic groups after the onset of the crisis. The third paper mainly focuses on population health status. It studies how economic climate and uncertainty influence fertility decisions and responses across population groups, and further investigates whether economic conditions during pregnancy impact newborn health. Our findings generally suggest that birth weight and pregnancy length are procyclical. We also report heterogeneity in the relationship between economic conditions during pregnancy and newborn health across socioeconomic groups, with the birth outcomes of high-SES newborns being responsive to economic volatility only in the first trimester of pregnancy. Further, economic adversity during the preconception period increases the probability that women who conceive are highly educated and married. After accounting for selection, we find that newborns exposed to the crisis while in utero tend to be lighter, with the effect being more detrimental for low-SES children.

Item Type: Thesis (PhD)
Additional Information: © 2019 Ilias-Ioannis Kyriopoulos
Library of Congress subject classification: H Social Sciences > HC Economic History and Conditions
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Social Policy
Supervisor: Mossialos, Elias

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