Nabila Tabassum Chowdhury > Recent Status Updates

"A third problem is outright fraud: What is to prevent a hospital from presenting to the insurer a large number of bogus claims or charging the patient substantially more than the cost of care received?"

"Another issue is“adverse selection.”If insurance is not mandatory,those who know they are likely to have a problem in the future may be more likely to get insurance.This would be fine as long as the insurer also knows that,because it could be factored into the premium But if the insurance company is unable to identify those who are joining because they want care now,all they can do is raise the premium on everyone."

"Patients want to see action, so they tend to prefer doctors who are prescription happy, and the doctors often make more money if they prescribe more. Offering reimbursement-based health insurance for outpatient care in a country where health care is at best weakly regulated, and where anybody can set up shop as a “doctor,” seems like the first step toward bankruptcy."

"When a family has a bad harvest, or when someone loses his or her job, other families in the village come to the rescue. The affected family receives gifts, interest-free loans, and various other forms of assistance. But when individuals suffer a health shock, this is apparently not the case. The family is left to deal with it."

"The risk borne by the poor is thus not only costly once a shock hits: The fear that something bad might happen has a debilitating effect on poor people’s ability to fully realize their potential."

"If coping by working more after the shock hits is not really a good option, the best bet is often to try to limit exposure to risk by building, like a hedge-fund manager, a diversified portfolio, and it is clear that the poor invest a lot of ingenuity in doing so. The only difference is that they diversify activities, not just financial instruments."

"For the poor, risk is not limited to income or food: Health, which we discussed in a previous chapter, is one major source of risk. There is also political violence, crime (as in the case of Ibu Tina’s daughter), and corruption."

"The problem was not just the level of prices, but also the uncertainty. Farmers, for example, who were paying high prices for fertilizer were not sure whether the price of their produce would still be high when they were ready to harvest."

"In summer 2008, however,a record year for the prices of both food and fertilizer,everyone we talked to in countries such as Indonesia and India felt that they were holding the short end of the stick:Farmers thought that their costs had increased more than their prices; workers complained that they could not find work because farmers were saving money; at the same time, city dwellers were struggling to pay for food."

"Risk is a central fact of life for the poor, who often run small businesses or farms or work as casual laborers, with no assurance of regular employment. In such lives a bad break can have disastrous consequences."

"The most effective population policy might therefore be to make it unnecessary to have so many children (in particular, so many male children). Effective social safety nets (such as health insurance or old age pensions) or even the kind of financial development that enables people to profitably save for retirement could lead to a substantial reduction in fertility and perhaps also less discrimination against girls."

"But it is only when a grandmother lived with a granddaughter that the granddaughter benefited: Those girls were significantly less likely to be stunted. Pensions received by a grandfather had no such effect. And there is more: Only if the pension was received by the girl’s maternal grandmother was this effect seen."

"In a study with Udry, Esther found that in good “male” years, more is spent on alcohol, tobacco, and personal luxury items for men (such as traditional items of clothing). In good “female” years, more resources are spent on little indulgences for women but also on food purchases for the household. What is particularly odd about these results is that spouses do not seem to be “insuring” each other."

"In Côte d’Ivoire, women and men traditionally grow different crops. Men grow coffee and cocoa, whereas women grow bananas, vegetables, and other staples. Different crops are affected differently by the weather: A particular rainfall pattern may result in a good year for the male crops and a bad year for the female crops."

"But most of the fertilizer in the Burkina Faso households was used on the husband’s plot: By reallocating some of the fertilizer plus a bit of labor to the wives’ plots, the family could increase its production by 6 percent without spending an extra penny. Families were literally throwing money away because they could not agree on the best way to use the resources they had."

"Using a little bit of fertilizer on a plot increases its productivity a great deal, but increasing the amount beyond that initial level does not do very much—it is more effective to use a little bit of fertilizer on all the plots than a lot of fertilizer on just one plot."

"The data squarely rejected this view: Instead, plots farmed by women were allocated systematically less fertilizer, less male labor, and less child labor than plots farmed by men. As a result, these households systematically produced less than they could have."

"Christopher Udry tested this prediction in rural Burkina Faso, where each household member (the husband and the wife, or wives) works on a separate plot In an efficient household, all inputs (family labor, fertilizer, and so forth) should be allocated to the various plots in a way that maximizes total family earnings."

"Family decisionmaking came to be seen as the result of a bargaining process among family members (or at least between the two parents)."

"Yet most societies rely on the goodwill of the parents to make sure that children get fed, schooled, socialized, and taken care of more generally. Given that these are the same parents who contrive to let their little girls die, how much faith should we place in their ability to get this done effectively?"

"What all of this underscores is the violence, active and passive, subsumed within the functioning of the traditional family. This was, until fairly recently, ignored by most (though not all) economists, who preferred to leave that black box closed."

"Andrew Foster and Mark Rosenzweig studied this and found that the mortality differential between boys and girls decreases when a girl’s marriage prospects are brighter; in contrast, economic growth in the village, which increases the value of investing in boys (because they stay home), leads to a widening of the mortality gap between boys and girls."

"Whatever the exact mechanics of discrimination against baby girls(or potential baby girls),the fact remains that the world has many fewer girls than human biology would predict.In the 1980s,in a now classic article in the New York Review of Books,Amartya Sen calculated that there were 100 million“missing women”in the world.This was before sex-selective abortion was available—and things have only gotten worse since."

"Even if their children don’t die before or after birth, when parents prefer boys, they may have children until they have the number of boys they want."

'Indeed, if investing in children tends to have a much higher return than investing in financial assets (after all, feeding a child is not that expensive), families may actually be poorer in a lifetime sense when they have fewer children."

"The very strong substitution between family size and savings may help us explain the surprising finding that having fewer children does not translate into healthier or better-educated children: If parents who have fewer children expect lower money transfers in the future, they also need to save more in anticipation, and this cuts into the funds they have available for investing in the children they have."

"For many parents, children are their economic futures: an insurance policy, a savings product, and some lottery tickets, all rolled into a convenient pint-size package."

"But the social norms may also reflect economic interests in a society. To what extent do the poor want many children simply because it is a sound economic investment?"

"At the same time, what leads them to make these choices may be in part factors that are outside their immediate control: Women, in particular, may be pressured by their husbands, their mothers-in-law, or social norms to bear more children than they would like."

"the answer to the question “Do the poor control their family decisions?” thus seems to proceed in two steps. At the most obvious level, they do: Their fertility decisions are the product of a choice, and even the lack of availability of contraception does not seem to be a big constraint."