Incorporating Discrete Choice Experiments into Policy Decisions: Case of Designing Public Long-Term Care Insurance
Discrete choice experiments (DCEs) have been widely used to elicit preferences in the health economics field but recent reviews found that DCE results are rarely incorporated into health policy decisions. We conjecture that one reason is most health policy practitioners only focus on estimating marginal willingness to pay (MWTP), the measure that is not directly applicable for policy-related questions. We show that when designing a new program, translating preference information into the demand for packages and benefits of alternative schemes (the choices made available) can make the DCE results more policy relevant. This concept is illustrated using data collected to evaluate the benefits of introducing a public long-term care insurance program to a middle-income country, Thailand. We find that preferences are very heterogeneous, implying that no one-size-fits-all solution exists. The estimates from the preferred model are then used to calculate benefits and losses (based on the consumer surplus measure) for plausible implementation scenarios such as different universal schemes, multiple-tier schemes, and schemes in which premium are subsidized for low-income households.
Labor Income Inequality in Thailand: the Roles of Education, Occupation and Employment History
Thailand’s income inequality has reportedly declined since the mid-1990s. This paper examines possible mechanisms underlying the dynamic patterns of the country’s labor income inequality. Using the Thai labor force survey between 1988 and 2017, we document that the country’s reduction in income inequality is likely driven by the fact the earnings at the bottom part of the distribution have become more similar. The median wage gap between college and non-college workers, however, still gets larger over time. Our key explanation is the changes in education-occupation composition. Recently college graduates are no longer concentrated in high skill jobs. A larger share of secondary educated workers works in low-skill jobs instead of the middle-skill ones. Using panel administrative data from the Thai Social Security Office, we find that wage disparity can also be explained by employment history. The high wage earners earn more since they enter the market, and the gap gets wider as the workers age. Additionally, the top of the group can command higher wages by working at a large firm or switching to a new job. These findings highlight the fact that to tackle the income inequality issue, the country needs to understand the underlying mechanisms behinds its dynamics.
The European Smoking Bans and Mature Smokers: Can They Kick the Habit?
Using individual level data, this paper investigates whether nationwide smoke-free legislations in Europe lead to smoking reduction and cessation among mature smokers. It exploits cross-country data and the European Union’s multinational governance that provides a quasi-experimental setting. Top-down regulations on smoke-free environment by the EU mitigate the self-selection bias and endogeneity bias of smoke-free laws generally faced in other settings. The results show that comprehensive bans lower smoking propensity by approximately 7 percent and reduced smoking intensity by 10 percent. The effect persisted and increased over time. Light smokers and heavy smokers were 14.5 and 7.2 percent more likely to quit while there is no significant effect on average smokers. Those working in industry and occupation that faced with more comprehensive and strict bans were also more likely to quit, showing that comprehensive bans can increase smoking cessation even among mature smokers with well-established addiction.
“Gold Miss” or “Earthy Mom”? Evidence from Thailand
This paper investigates the impact of Thai women’s education on their marriage behavior and fertility. It first uses the data set from the Labor Force Survey to estimate the effect of education on the marriage market. The result from applying the recent doubly robust Inverse Probability Weighted Regression Adjustment (IPWRA) indicates that obtaining a university degree decreases the probability of women’s marriage by 14.8%, emphasizing the rise of the “Gold Miss” phenomenon in Thailand. It further examines the effect of education on fertility. By applying both the instrumental variable using the compulsory education reform as an instrument and pseudo-panel approaches to take into account the endogeneity of schooling, the result shows that education causally reduces fertility, which provides a convincing sequential explanation for the dramatic decline in fertility in Thailand.
Estimating Demand for Long-term Care Insurance in Thailand: Evidence from a Discrete Choice Experiment
At present, the Thai public health insurance schemes cover medical care. However, the financial risk associated with long-term care needs is unprotected. The increasing likelihood of Thai elderly living longer and living alone has raised great concern about their quality of life. In the wake of the declining informal support capacity, a public long-term care insurance (LTCI) system has been considered as a potential alternative. Because the public will have to contribute to the LTCI fund, this paper explores whether the Thai people are willing to pay for such a provision. The LTCI demand is estimated based on the stated preference survey data. Our results show that most respondents are willing to pay to insure against their risk associated with long-term care expenditure, but their preferences are very heterogeneous. Gains and losses for different policy scenarios, measured by consumer surplus, are discussed.
An Early Evaluation of a HighScope-Based Curriculum Intervention in Rural Thailand
This paper evaluates the early impact of an early childhood curriculum intervention on child development. Impact is measured at the end of the academic year, one year after implementation. Teachers in rural childcare centers in northeastern Thailand were encouraged to employ the new curriculum, which is based primarily on the HighScope approach. We overcome the endogenous decision of teachers to adopt the new curriculum by using the randomization of additional teachers as an instrument. We find that the new curriculum significantly improved child development in multiple dimensions, including gross motor, fine motor, expressive language, and personal and social skills. We also find evidence that exposure to the new curriculum significantly helps children with absent parents more than children with at least one parent present. The results are robust with regards to various estimation methods, child development measures, and sample selections.
Educational Assortative Mating and Income Inequality in Thailand
This study measures educational assortative mating in Thailand and its relationship with income inequality using national labor force survey data from 1985-2016. Since the 1990s, Thailand shows a trend of decreasing educational homogamy, but there is evidence of continuing educational hypergamy in Thai households. Using the semiparametric decomposition method of DiNardo, Fortin and Lemieux (1996), the study finds that educational assortative mating has affected changes in household income inequality over time. Furthermore, there exists a negative relationship between income inequality and marital sorting with same education, which contradicts evidence found in developed countries.
The Impact of Cash Transfers on Child Outcomes in Rural Thailand: Evidence from a Social Pension Reform
Unlike standard literature on the social pension policy and children’s outcomes, this paper provides evidence from Thailand that an introduction of small (equivalent to 2-3 days of minimum wage) but universally covered social pension can affect educational choice and work status of children living with eligible pensioners. Such a result seems to be driven by the characteristics of newly eligible pensioners who are not as poor as the pensioners under the targeted program before the reform. Our findings also show differential effects of the social pension by genders of the children and pensioners. In particular, teenage boys living with male pensioners are more likely to enroll in the secondary school compared to children in the control group living with almost eligible seniors, while the results for teenage girls are rather inconclusive.
Overoptimistic Entrepreneurs: Predicting Wellbeing Consequences of Self-Employment
The formation of expectations is a fundamental part of the process when people decide about engaging in an entrepreneurial venture. We evaluate the accuracy of newly self-employed people’s predictions of their overall future wellbeing. Based on individual panel data for Germany, we find that they are overly optimistic when we compare their predicted life satisfaction with their actual life satisfaction five years later on. This overoptimism also holds for those entrepreneurs who successfully remain in business for at least five years. A possible reason might be that they underestimate the heavy workload reflected in higher working hours than desired and the drop in leisure satisfaction.
Welfare Analysis of the Universal Health Care Program in Thailand
I estimate and decompose the welfare benefit of Thailand’s universal health care policy, also known as the 30 Baht program. The total welfare impact of the 30 Baht program is defined as the amount of consumption that an enrollee would need to give up that would leave her at the same expected utility as without the 30 Baht program. I find that the total welfare benefit is approximately 75 cents per one dollar of government spending. The main source of the welfare effect can be attributed to improved consumption smoothing rather than increases in the consumption level. Using difference in differences method, I find that the effect of the 30 Baht program on income is signicantly positive, while the effect on consumption is slightly negative but not significant. This implies that the 30 Baht program has a positive impact on savings and future consumption, rather than current consumption.