文档介绍：THE
QUARTERLY JOURNAL
OF ECONOMICS
Vol. CXXV February 2010 Issue 1
FREE DISTRIBUTION OR COST-SHARING? EVIDENCE
FROM A RANDOMIZED MALARIA PREVENTION
EXPERIMENT∗
JESSICA COHEN AND PASCALINE DUPAS
It is often argued that cost-sharing—charging a subsidized, positive price—
for a health product is necessary to avoid wasting resources on those who will
not use or do not need the product. We explore this argument through a field ex-
periment in Kenya, in which we randomized the price at which prenatal clinics
could sell long-lasting antimalarial insecticide-treated s (ITNs) to pregnant
women. We find no evidence that cost-sharing reduces wastage on those who will
not use the product: women who received free ITNs are not less likely to use them
than those who paid subsidized positive prices. We also find no evidence that cost-
sharing induces selection of women who need more: those who pay higher
prices appear no sicker than the average prenatal client in the area in terms of
measured anemia (an important indicator of malaria). Cost-sharing does, how-
ever, considerably dampen demand. We find that uptake drops by sixty percentage
points when the price of ITNs increases from zero to $ (., from 100% to 90%
subsidy), a price still $ below the price at which ITNs are currently sold to
pregnant women in Kenya. bine our estimates in a cost-effectiveness anal-
ysis of the impact of ITN prices on child mortality that incorporates both private
and social returns to ITN usage. Overall, our results suggest that free distribution
of ITNs could save many more lives than cost-sharing programs have achieved so
far, and, given the large positive externality associated with widespread usage of
ITNs, would likely do so at a lesser cost per life saved.
∗We thank Larry Katz, the editor, and four anonymous referees ments
that significantly improved the paper. We also thank David Autor, Moshe Bushin-
sky, Esther Duflo, William Easterly, Greg Fischer, R