Demand-side Factors Research Articles

Re-examining ‘personalised conditionality’: full-time obligations, partial adjustments and power asymmetries in the UK’s approach to work-related conditionality

Abstract Work-related conditionality policy in the UK is built around the problematic assumption that people should commit to ‘full-time’ work and job search efforts as a condition of receiving benefits. This is potentially in conflict with the idea that what is required of people should be tailored to their circumstances in some way – ‘personalised conditionality’ – and implies a failure to recognise that conditionality is being applied to a diverse group of people and in a context where the paid work that is available is often temporary and insecure. Drawing on thirty-three qualitative interviews with people subject to intensive work-related conditionality whilst receiving Universal Credit or Jobseeker’s Allowance in Manchester, the paper explores the work-related time demands that people were facing and argues that these provide a lens for examining the rigidities and contradictions of conditionality policy. The findings indicate that expectations are often set in relation to an ideal of full-time hours and in a highly asymmetric context that is far from conducive to being able to negotiate a reasonable set of work-related expectations. Work search requirements affect people differently depending on their personal circumstances and demand-side factors, and can act to weaken the position of people entering, or already in, work.

Framework for responsive financing of district hospitals of India.

The current financing of public-sector district hospitals in India relies on historical budget allocations rather than actual utilization or healthcare needs. We utilized empirical data on healthcare delivery costs to develop the financing framework for these hospitals using a blended payment approach. The primary data on cost of delivering services in 27 district hospitals across nine states of India was analysed along with indicators influencing the demand and supply of health services. Payment for outpatient, inpatient, and indirect services was assessed using the risk adjusted global budget, case-based bundled payment, and per-bed-global budget, respectively. Risk adjustment weights were computed by regressing the cost of outpatient care with demand and supply side factors which are likely to influence the utilization or the prices. Budget impact analysis was conducted to assess the fiscal implications of this payment approach, accounting for current care standards and two scenarios: upgrading district hospitals to Indian Public Health Standards (IPHS) or medical colleges. The average annual budget for a district hospital in India is estimated at ₹326 million (US$3.35 million), ranging from ₹66 million to ₹2.57 billion (US$0.8-31.13 million). Inpatient care comprises the largest portion (78%) of the budget. Upgrading to IPHS-compliant secondary hospitals or medical colleges would increase average budgets by 131 and 91.5%, respectively. Implementing a blended payment approach would align funding with healthcare needs, enhance provider performance, and support ongoing financing reforms aimed at strategic purchasing and universal health coverage.

Why “free maternal healthcare” is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power

BackgroundGhana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana’s free maternal healthcare policy.MethodsCross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network analysis, identifying basic, organising themes and global themes.ResultsWe found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose from health systems factors, particularly, NHIS structural issues – delayed and insufficient reimbursements, inadequate NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors – mothers’ lack of education about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges, healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling the persistence of out-of-pocket payments for maternal healthcare.ConclusionsUrgent measures are required to address the structural and administrative issues confronting Ghana’s free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.

Blockchain enabled traceability — An analysis of pricing and traceability effort decisions in supply chains

Despite numerous use cases, enterprise-wide implementations of blockchains have seen limited success. This raises the question of when do firms adopt blockchains and do blockchains benefit supply chains. To answer this, we examine a dyadic supply chain consisting of a buyer and a supplier and analyze their traceability effort and pricing decisions. Our results show that the demand-side, supply-side and reputational factors influencing blockchain adoption are primarily complementary and in the absence of one of them, firms can still adopt blockchain. Furthermore, even in the absence of individual benefits for a supply chain partner, there exist conditions under which blockchain adoption benefits the supply chain that can incentivize players to join blockchain. Overall, we contribute by offering a framework that supply chain players can use to assess the likelihood of blockchain implementation success or failure and address the challenges pertaining to incentives and cost imbalances in blockchain implementation.

The gender gap in executive promotions

This paper examines whether there is a gender promotion gap among executives. Using a comprehensive dataset of executives, I find that women’s promotion probability is 16% lower than men’s after controlling for educational and employment background, age, function, rank, and firm characteristics. The gap occurs partially because women are clustered in positions that support the business rather than positions with profit-and-loss responsibilities. Additionally, my analysis shows that product market competition, public attention on gender diversity, a respectful corporate culture, and board gender diversity alleviate the gender promotion gap. These findings support the notion that demand-side factors continue to hinder women’s advancement to leadership positions.

Long-Term Elasticity of Environmental Demand: Environmental Protection Expenditures in Sweden, 1972–2020

This study uses reconstructions of historical Environmental Protection Expenditure Accounts (EPEA) in Sweden from 1970–2020 to present a time series approach that analyses the demand for environmental services. The paper’s aim is to analyse environmental adaptation as a historical, economic and environmental process and to explore structural shifts suggestive of an overall periodisation of environmental demand. The article contributes to a deeper understanding of demand-side factors in environmental adaptation as part of contemporary economic history. The investigation also provides evidence that the income elasticity of environmental demand was slightly higher than 1.0 and largely stable over time, and even though we were able to detect trend breaks, there is insufficient evidence for major structural breaks suggesting sharp shifts in societal environmental preferences. Policies requiring sharply rising environmental expenditures should consider this level of historical stability. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0 .

Long-Run Trade Relationship between the U.S. and Canada: The Case of the Canadian Dollar with the U.S. Dollar

This study investigates the long-run relationship between the U.S. dollar and the Canadian dollar by analyzing the bilateral exchange rate induced by nominal and real shocks. The methodology centers on a structural vector autoregressive (SVAR) model, including the analysis of impulse response and variance decomposition to account for the impact of nominal and real shocks on exchange rate movements. This study also decomposes real shocks into demand and supply factors from both Canada and the U.S. and compares their impacts on the nominal and real exchange rates. The results are compared to shocks driven by country-specific nominal factors. This study uses quarterly data from December 1972 to December 2023. The findings suggest that real shocks have a permanent impact on both the nominal and real exchange rates, compared to nominal shocks, which have a temporary impact. Country-specific real supply-side factors have a more significant impact than country-specific real demand-side factors. Country-specific nominal factors barely impacted the nominal and real exchange rates between the U.S. and Canada.

Violent conflict and the demand for healthcare: How armed conflict reduces trust, instills fear, and increases child mortality

What are the health effects of violent conflict? It is well known that wars kill civilians away from the battlefield and long after the fighting has stopped. Yet why this happens remains only partially understood. While we have good evidence that factors such as the destruction of infrastructure, political neglect, and the out-migration of health workers – what may be called supply-side factors – negatively affect health outcomes, we know much less about how violence shapes the attitudes and behavior towards healthcare use among civilians exposed to violent conflict – what may be called demand-side factors. Here, I theorize that exposure to violence suppresses civilian demand for healthcare through two mediating channels – mistrust of government institutions and fear of future violence – with adverse consequences for health outcomes, particularly child health. To test this theory empirically, I combine information from over 80,000 interviews conducted in 22 conflict-affected countries in Africa with individual- and context-level measures of exposure to violent conflict. Exposure to violence is associated with significantly lower levels of political trust and increased fear of future violence, which in turn predict lower healthcare utilization, lower immunization rates, and higher infant and child mortality. To fully address the health consequences of armed conflict, it is essential that we better understand the attitudinal and behavioral correlates of exposure to violence.

Evaluating the Effects of Public Debt on Sri Lanka’s Economic Growth: A Short-term and Long-term Perspective

Aims: The objective of this paper is to examine whether public debt enhances economic growth in Sri Lanka by separating debt into domestic and external debt. Study Design: The paper adopts the Keynesian demand-side model to estimate GDP on demand-side and supply-side factors such as domestic debt, external debt, gross fixed capital formation (investment in short), labour force, general price level, money supply, government spending and trade openness. In a model where debt causes investment, public debt effects are netted out from investment by removing the estimated investment effects of domestic and external debt. Duration of Study: quarterly data from Q1 2010 to Q1 2023 are utilized to trace the long-term and the short-term effects of domestic and external debt on GDP. Methodology: The ARDL method of estimation is used and the model is estimated in double log form so that estimated parameters reflect output elasticities. A general to specific modelling approach is adopted to find the best suited model. Results: Variables such as government spending, money supply, general price level and labour force are not relevant while domestic debt, external debt, investment (debt effects netted out) and trade openness are significant in describing GDP. The long-term domestic debt elasticity of GDP is 0.588 while short-term domestic debt elasticity (sum of contemporaneous and lag effects) is about 0.63. The cumulative effects of domestic debt on GDP tappers off to 0.60 in the long-run. The result suggests negative impacts (-0.272 and -0.254) of external debt on the economic growth in short-term and long-term respectively. The negative effect of external debt can be justified if recent external borrowings have been used to repay loans taken to finance war and unproductive projects. Conclusion: The paper finds that the domestic public debt creates relatively strong positive effects on GDP in the short-term and the long-term. Contrary to the expectations, the effects of external debt on GDP have become negative both in the short-term and the long-term. The paper also finds that debt effects on GDP have been significantly reduced when debt effect-ridden investment variable is included in the regression in place of debt-effect netted out investment. Thus, this study recommends researchers to carry out further research on why the effects of external debt on GDP become negative. Further, it recommends policy makers to use both domestic and external debt to finance public investment and productivity enhancement projects rather than borrowing merely for the purpose of consumption and repaying of existing debt.

Self-selection out of formal credit markets: evidence from rural Vietnam

PurposeThis paper examines why farmers self-select out of formal credit markets even though they need external funds.Design/methodology/approachWe use probit and Bayesian probit estimators to detect the determinants of self-selection behavior based on a primary dataset of 2,212 rice farmers in Vietnam. After that, we use the multinomial probit (MNP) and Bayesian MNP estimators to reveal the impact of relevant factors on the decision to self-select for farmers belonging to each self-selection category.FindingsThe probit and Bayesian probit estimators show that the decision to self-select depends on household head age, income per capita, farm size, whether or not to have relatives or friends working for banks, the number of previous borrowings, risks related to natural disasters, diseases, and rice price, and the number of banks with which the farmer has relationships. The MNP and Bayesian MNP estimators give further insights into the decision of farmers to self-select in that determinants of the self-selection behavior depend on the reasons to self-select. In concrete, farm size and the number of previous borrowings mitigate the self-selection of farmers who did not apply for loans due to having access to other preferred sources of credit. The self-selection of farmers not applying for loans because of unfavorable loan terms is conditional on household head age, farming experience, income, farm size, the number of previous borrowings, natural disaster risk, and the number of banks the farmer has relationships with. Several factors, including education, income, the distance to the nearest bank, whether or not having relatives or friends working for banks, the number of previous borrowings, risks, and the number of banks the farmer has relationships with, affect the self-selection of farmers not applying for loans because of high borrowing costs. The self-selection of farmers not applying for loans because of complex application procedures depends on income and the number of previous borrowings. Finally, the household head’s age, gender, experience, income, farm size, the amount of trade credit granted, the number of previous borrowings, natural disaster risk, and the number of banks the farmer has relationships with are the determinants of the self-selection of farmers not applying for loans because of a fear not being able to repay.Practical implicationsThis paper fills the knowledge gap by investigating why farmers self-select out of formal credit markets. It provides evidence of how the farmers’ subjective perceptions of rural credit markets contribute to their self-selection.Originality/valueThis paper shows that demand-side constraints are also vital for farmers’ access to bank credit. Improving credit access via easing supply-side constraints may not increase credit uptake without addressing demand-side factors. Given that finding, it recommends policies to improve access to bank credit for farmers regarding the demand side.

Hereditary Democracy

Abstract: Hereditary democracy is the phenomenon whereby the children, spouses, or other close family members of powerful politicians are themselves elected to high office. It is a ubiquitous feature of democracy worldwide. What causes it? What are its consequences? To explain hereditary democracy, the article develops a framework that looks at both supply- and demand-side factors, with respect to both the voting masses and party elites, that contribute to an inherited incumbency advantage. The article argues that the practice of hereditary democracy should be condemned. While it has helped women leaders to reach high office in unlikely places, it artificially shrinks the pool of political talent, can lead to disappointed voter expectations, and is fundamentally unfair.

Drivers of public procurement prices: Evidence from pharmaceutical markets

This paper examines the determinants of public procurement prices using comprehensive data on pharmaceutical purchases by the public sector in Chile. We first document sizable price differences between buyers for the same product and quantity purchased: the difference between the average prices paid by buyers at the 90th and 10th percentiles of the distribution is 16 percent. Our main results are related to the importance of market structure in explaining the dispersion in procurement prices. We find that market structure explains three times more dispersion than buyer effects. Moreover, we leverage exogenous variation in market structure due to patent expirations to estimate that the entry of an additional seller decreases average procurement prices by 11.7 percent, which is 72 percent of the price differences implied by the gap between the 90th and 10th percentiles of estimated buyer effects. These results suggest that supply-side factors are relevant determinants of public procurement prices and that their quantitative importance may exceed that of demand-side factors previously emphasized in the literature.

The Dual Impact of Economic Growth and Trade Openness in Explaining the Gender-Gap in Employment: Case of Arab Countries

This study aims at investigating the dual impact of trade openness and economic growth on gender-gap in employment for selected Arab countries in the last three decades. The panel data were extracted from the World Bank Indicators (WBI). To account for potential heterogeneity and non-stationarity in some series, the method of Weighted estimation for Dynamic Least Squares (DOLS) is used. The main findings substantiate the importance of both demand side factors such as economic growth and trade openness on gender-gap in employment as well as the supply side factors like education and fertility rate. The main variable of concern which is the trade openness has revealed as expected a positive and highly significant impact on gender-gap in employment. The GDP growth shows negative and significant impact on the gender-gap in employment, which was in favor of more male employment. Other factors such as education were no more drivers for more female employment but it might be driver for more female unemployment. It shows a negative impact for only young females but it was insignificant for other groups. Finally, fertility rates and urbanization have shown as expected a negative and significant impact on gender-gap in employment which still band more female employment with lack of convenient and affordable child care services.

Supply and Demand: Drivers of Women Non-Combat Participation in Rebel Groups

Including women into their ranks offers non-state armed groups advantages in terms of mobilisation, intelligence gathering, and establishing ties with civilians. However, especially in conservative societies, this inclusion of could also cause backlash from group members and supporters. While several previous studies analyse why rebels choose to recruit female combatants, limited attention has been paid to women in non-combat roles. I address this gap by studying the drivers of women’s inclusion into rebel groups as non-fighting members, hence contributing to wider efforts to bring gender-sensitive approaches to research on security and violence. Specifically, I conduct a qualitative comparative analysis (QCA) of 118 groups in the period 1989–2015. The results indicate that a conjunction of supply-side factors (female unemployment, gender inequality) and demand-side factors (leftist ideology, territorial control, military strength) drive female non-combat participation in rebel groups. The causal impact of women’s marginalisation is highly context-dependent: Leftist rebels’ calls for gender equality are appealing to (particularly poor and excluded) women. Yet, rebels with high demand for skilled labour prefer to recruit non-marginalised women that received at least some job training.

Barriers to Seek Professional Help for Mental Health Scale: Development and Psychometric Validation

Background: Mental health conditions are highly prevalent, and both supply- and demand-side factors drive a high treatment gap. There is a dearth of socio-culturally appropriate measures to assess barriers to professional help-seeking in distressed non-treatment seekers. This study aimed to develop and validate the Barriers to Seek Professional Help for Mental Health Scale for distressed, non-treatment-seeking young adults experiencing common mental health concerns in the Indian context. Methods: The study was conducted in three phases: Phase I: development of initial measure; Phase II: scale try-out ( N = 190); and Phase III: validating the factor structure ( N = 172). Distressed, non-treatment-seeking young adults (20–35 years old) were recruited for the present study. Exploratory factor analysis (EFA) was used to identify the factor structure, and confirmatory factor analysis (CFA) was conducted to validate it. Results: EFA showed that a five-factor structure best fits the data, namely, stigma and minimization, instrumental barriers, problem perception, self-efficacy in service utilization, and negative service expectancies. CFA revealed that the model was a reasonably good fit. The scale was finalized into a 24-item measure. Internal consistency reliabilities of the scale and subscales were satisfactory. Correlation patterns of barriers subscales with help negation, help-seeking inclination, and distress support its convergent validity. Conclusion: The Barriers to Seek Professional Help for Mental Health Scale was developed, and preliminary evidence supports its reliability, construct, and convergent validity. The scale could prove valuable for assessing barriers to seeking professional help for mental health in the Indian context, developing help-seeking interventions, and examining their effectiveness in increasing the uptake of mental health services.

Incumbent inertia, innovativeness, and performance (dis)advantages: A demand-side learning perspective

Strategies of incumbent firms have received considerable attention in marketing and across business disciplines, but findings regarding performance (dis)advantages and innovativeness are mixed. Prior studies on supply-side sources (factors internal to the firm) of incumbent inertia disadvantages are more prevalent than those on demand-side factors, which relate to a firm’s customers and may explain potential incumbent advantages. We introduce an integrated demand-side framework to incumbent inertia, recognizing how the supply- and demand-side factors interrelate through learning mechanisms. On the one hand, incumbent firms learn and develop various routines and assets that influence their product strategies, typically reflecting inertia and incremental innovation. At the same time, customers learn about products in the market, forming preferences that reflect switching costs and network externalities (demand-side factors). Although an incumbent can gain advantages from demand-side effects, this could accelerate the onset of supply-side disadvantages. We present a set of research propositions that specify critical effects, and examine implications for incumbent strategies.

Low-value care: an evolutionary concept analysis

Abstract Background: Low-value care is a significant contributor to health care waste and a threat to the viability and sustainability of health care systems. Low-value care has attracted increasing international attention in the last decade, but its precise conception remains elusive. Objective: To clarify the concept of low-value care. Methods: A systematic search was conducted of the Medline, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases from their inception to July 22, 2023 for articles written in English. Rodgers’ evolutionary method guided the narrative analysis. The attributes of low-value care, as well as its antecedents, consequences, and related terms were extracted and synthesized. Results: A total of 53 articles were included in this concept analysis. Defining attributes included being of little to no benefit or potentially harmful, not being cost-effective, occurring along a continuum, being relative, ignoring or disregarding patient wishes in certain circumstances, and involving multiple types of care. Low-value care antecedents were classified into 4 categories: demand-side factors, supply-side factors, social factors, and health care system factors, while consequences of low-value care were categorized into patient harms and health care system-related consequences. Conclusions: This in-depth analysis of attributes, antecedents, and consequences of low-value care promotes a better understanding of low-value care among health care providers, thus contributing to the identification and deimplementation of low-value care in practice and eventually contributing to reducing waste in health care spending and improving patient outcomes.

Exploring Factors and Disparities: Female Labor Force Participation in the Palestinian Regions: East Jerusalem, West Bank and Gaza Strip

This paper investigates Female Labor Force Participation (FLFP) across the Palestinian regions of East Jerusalem, the West Bank, and the Gaza Strip. Utilizing data from the Palestinian Central Bureau of Statistics spanning from 1999 to 2018, we employ logistic regression models and age-period-cohort analyses to examine the determinants and trends shaping FLFP. Despite a notable increase in FLFP rates in Gaza since 2008, East Jerusalem witnesses a declining trend, widening the gap between East Jerusalem and the West Bank/Gaza strip. Our investigation aims to elucidate these regional differences, considering both supply-side and demand-side factors. Supply-side factors encompass social and gender norms, as well as social structure, while demand-side factors include structural changes in the economy over time, the availability of public sector employment, predominant economic activities engaging women (services and agriculture), and the repercussions of economic shocks on FLFP (added worker effect), among other factors.

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Background This study is a systematic review of barriers and facilitators of supply-side maternal, newborn, and child health (MNCH) service availability in the Democratic Republic of the Congo (DRC). Given gaps in understanding of the factors affecting supply-side service availability, authors reviewed the literature to describe the DRC’s landscape and inform future research and programming. # Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors searched two databases and grey literature, using the Quality Assessment with Diverse Studies tool to assess quality. Authors identified key themes and used a narrative approach to analyze extracted data. # Results The search identified 2160 articles, with 26 meeting the inclusion criteria. Authors grouped them according to the following key themes: facility readiness, human resources for health (HRH), geography and transportation, conflict, financing, and governance. MNCH service availability was hindered by lack of supplies, logistical challenges, weak infrastructure, unmet staffing needs, HRH turnover, poor HRH distribution, career and payment obstacles, long distances to facilities and poor transportation, system strain and disruption due to conflict, low government expenditure, high out of pocket costs, fragmented stakeholders, and low government prioritization. Authors found facilitating factors in each key theme, including parallel supply chains and buffer stocks, proactive staffing policies, motivated HRH, novel transportation methods, health posts, concentrations of stakeholders in conflict zones, universal health coverage policies, provider payment reforms, stakeholder coordination, and horizontal integration efforts. # Conclusions The DRC faces substantial supply-side barriers to MNCH service availability. Progress towards the Sustainable Development Goals and better MNCH outcomes requires additional work to build on existing facilitators and investments in service availability. Additional research on demand-side factors and quality of care could inform these efforts.

Trends in and Correlates of Short-Acting Contraceptive Stock-Outs: Multicountry Analysis of Performance Monitoring for Action Agile Platform Data.

Understanding trends in contraceptive stock-outs, as well as their structural and demand-side correlates, is critical for policymakers and program managers to identify strategies to further anticipate, reduce, and prevent stock-outs. We analyzed trends as well as supply- and demand-side correlates of short-acting contraceptive method stock-outs by using data from multiple rounds of Performance Monitoring for Action Agile surveys. These data longitudinally measured contraceptive availability over 2 years (between November 2017 and January 2020) across 2,134 public and private service delivery points (SDPs) from urban areas of 5 countries (Burkina Faso, Democratic Republic of the Congo [DRC], India, Kenya, and Nigeria). For each country, we analyzed the trends and used multilevel mixed-effect logistic regression to model the odds of short-acting contraceptive stock-outs, adjusting for key structural and demand-side factors of the SDPs. Stock-outs in short-acting contraceptive methods were common in health facilities and varied markedly, ranging from as low as 2.9% (95% confidence interval [CI]=1.7%, 5.1%) in India to 51.0% (95% CIs=46.8%, 56.0%) in Kenya. During the observation period, stock-out rates decreased by 28% in the SDP samples in India (aOR=0.72, P<.001) and 8% in Nigeria (aOR=0.92, P<.001) but increased by 15% in DRC (aOR=1.15; P=036) and 5% in Kenya (aOR=1.05, P=003) with each round of data collection. Correlates of stock-out rates included the facility managerial authority (private versus public), whether the facility was rated high quality, whether the facility was at an advanced tier, and whether there was high demand for short-acting contraceptives. In conclusion, stock-outs of short-acting contraceptives are still common in many settings. Measuring and monitoring contraceptive stock-outs is crucial for identifying and addressing issues related to the availability and supply of short-acting contraceptives.