UC San Diego

This dissertation is a collection of three essays on development and health economics. In the first essay, we studied two interventions that provide patients with information on antibiotic resistance through text messages in Beijing, China. The "self-health" intervention emphasizes the threat to one’s own health and is found to have negligible effects. In contrast, the "social-health" intervention highlighting the threat to society reduces antibiotic purchases by 17% without discouraging healthcare visits and other medicine purchases. Survey evidence suggests the perceived severity being a potential explanation. The messages were sent once every month for five months, and a gradual decrease in the effect size is observed over time.

The second essay evaluated the affordability and overuse trade-off in pharmaceutical pricing by studying a drug procurement program in China, which brought down the prices of 10 chronic condition drugs by an average of 78%. Using a difference-in-differences design with a set of comparable drugs as controls, we find that this improvement in affordability led to a significant increase in demand by uninsured patients, whose purchases of treated drugs increased by 28.4% more than the insured. This demand response came both from new and existing medication takers. Drug adherence was improved for the uninsured who had poorer adherence at baseline but overuse was not affected.

The third essay proposes two experiments related to low disease awareness, treatment take-up, and adherence in developing countries. Because of lacking access to primary care services, chronic condition awareness in developing countries is usually low. The first experiment proposes to provide people in low-income areas with physical exams and health reports to examine whether raising disease awareness could increase control. The second experiment proposes to provide patients with information on the expected benefit from treatment including the expected reduction in risk if their condition is under control, and the cost of a major health event. This experiment is designed to test the hypothesis that misperception of treatment benefits is one of the underlying causes for low take-up and adherence rates conditional on disease awareness in developing countries.