Health Economics Seminars (EUR)

Yubraj Acharya (University of Michigan, School of Public Health, United States)
Thursday, January 12, 2017

Outreach workers are used in many countries to improve access to health services, particularly for minority groups. The difference in ethnicity of an outreach worker and that of a prospective patient can limit the success of such efforts, as outreach workers may find it difficult to interact with individuals from a different ethnicity. Using a field experiment in Nepal, we document the extent of this problem and investigate if differential incentives can help overcome it. We varied the amount of financial incentives provided to health outreach workers by the ethnicity of the client they recruited for a free sugar-level assessment. We also varied the amount the clients received for appearing for the assessment. We find that the barriers due to ethnicity are high. Even a highly differential incentive in the ratio of 5:2, geared toward encouraging a cross-ethnic interaction, is insufficient to offset the barriers. In sub-group analysis, we find suggestive evidence that differential incentives to traditionally advantaged outreach workers have the potential to improve access for disadvantaged groups. We also find that the advantaged and disadvantaged health workers face different amounts of barriers to outreach efforts, with the latter likely facing a “stereotype threat”. Financial incentives to the clients had no effect on their decision to appear for the assessment.