Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment*
Open accessAbstract
It is widely believed 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 in the context of a field experiment in Kenya, in which we randomized the price at which pregnant women could buy long lasting anti-malarial insecticide-treated nets (ITNs) at prenatal clinics. We find no evidence that cost-sharing reduces wastage on those that 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 the net more: those who pay higher prices appear no sicker than the prenatal clients in the control group in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by 75 percent when the price of ITNs increases from 0 to $0.75, the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of ITN prices on infant mortality that incorporates both private and social returns to ITN usage. Overall, given the large positive externality associated with widespread usage of insecticide-treated nets, our results suggest that free distribution to pregnant women is both more effective and more cost-effective than cost-sharing.
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- Authors
- Cohen, J., & Dupas, P.
- Affiliations
- National Bureau of Economic Research (US)
- ORCID
- Cohen, Jessica
- Venue
- Quarterly Journal of Economics
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-02
- Volume
- 125
- Issue
- 1
- Pages
- 1-45
- ISSN
- 0033-5533 (ISSN-L)
- 1531-4650
- OpenAlex
- W3125419750
- Cited by
- 762
- References
- 5
- Citations by year
- 2026: 30 · 2025: 45 · 2024: 33 · 2023: 32 · 2022: 36 · 2021: 41 · 2020: 67 · 2019: 42 · 2018: 48 · 2017: 60 · 2016: 54 · 2015: 48 · 2014: 57 · 2013: 54 · 2012: 42
- FWCI
- 47.40
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- The Quarterly Journal of Economics (publishedVersion)
- SSRN Electronic Journal (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Science Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Keywords
- cost sharing, free distribution, long-lasting insecticidal nets, malaria prevention, pregnant women, demand elasticity, anemia, child mortality, cost-effectiveness, social returns, externalities, Kenya
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