Abstract
Between 2000 and 2002, we followed 1621 individuals in Delhi, India using a combination of weekly and monthly-recall health questionnaires. In 2008, we augmented these data with another 8weeks of surveys during which households were experimentally allocated to surveys with different recall periods in the second half of the survey. We show that the length of the recall period had a large impact on reported morbidity, doctor visits; time spent sick; whether at least one day of work/school was lost due to sickness and; the reported use of self-medication. The effects are more pronounced among the poor than the rich. In one example, differential recall effects across income groups reverse the sign of the gradient between doctor visits and per-capita expenditures such that the poor use health care providers more than the rich in the weekly recall surveys but less in monthly recall surveys. We hypothesize that illnesses – especially among the poor – are no longer perceived as “extraordinary events” but have become part of “normal” life. We discuss the implications of these results for health survey methodology, and the economic interpretation of sickness in poor populations.
Highlights
How much does survey design affect survey results and, our view of the world? Why is it that the rich report more illnesses than the poor in a large number of surveys? These questions seem largely unrelated but are at the core of this paper
We investigate several ancillary specifications to check whether (a) these results could be driven by specific age populations, (b) specific respondents or, (c) whether the differential impact between the rich and poor could be picking up the effect of attributes correlated with per-capita expenditures (PCE), notably education
For all specifications, the interaction with education is in the expected direction—the impact of the recall period is lower for more educated households—but the effect sizes are small and generally lack precision
Summary
How much does survey design affect survey results and, our view of the world? Why is it that the rich report more illnesses than the poor in a large number of surveys? These questions seem largely unrelated but are at the core of this paper. The effect of recall on doctor‘s visits and the labor impact disappears entirely with the inclusion of the lagged morbidity interaction term, suggesting that when individuals and households have a large number of acute illnesses, they start to systematically forget entire episodes and it is precisely these households that drive the large observed differences between monthly and weekly reporting. This is consistent with our hypothesis that, in poor settings, individuals have come to treat sickness and doctor‘s visits as a regular part of their daily lives rather than an extraordinary event. For all specifications, the interaction with education is in the expected direction—the impact of the recall period is lower for more educated households—but the effect sizes are small and generally lack precision (except for the labor impact of acute illness, which is significant at the 90 percent level of confidence)
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