Panis C W, Lillard L A
RAND, Santa Monica, CA 90407.
J Health Econ. 1994 Dec;13(4):455-89. doi: 10.1016/0167-6296(94)90013-2.
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.
本文关注儿童死亡率与医疗保健使用之间的关系。我们构建了一个关于胎儿和产后死亡风险的联立模型以及产前医疗保健和机构分娩的投入需求方程。该模型应用于马来西亚半岛1950 - 1988年的回顾性数据。结果表明，产前医疗保健和机构分娩对儿童生存概率有显著的有益影响，并且当忽略医疗保健使用者中的逆向自我选择时，这些影响被大幅低估。马来西亚产前医疗保健的效果在1980年之前有所改善，之后则恶化。我们发现婴儿和儿童死亡风险并非独立于胎儿存活情况，但表明忽略选择性胎儿存活在婴儿和儿童死亡率估计中仅引入轻微偏差。年轻母亲中较高的婴儿和儿童死亡率部分可归因于她们购买医疗保健的可能性较低。
