Doctoral Degrees (Economics)

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Using apple product prices to evaluate the law of one price and product derived real exchange rates
(Stellenbosch : Stellenbosch University, 2023-12) Walker, Ernest Edward; van Lill, Dawid; Hollander, Hylton; du Rand, Gideon; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Empirical literature on the law of one price or purchasing power parity suggests that real exchange rate deviations are more persistent than economic theory would predict. To evaluate these deviations, I construct two novel panel datasets consisting of Apple product prices. The first dataset covers iPod, iPad, and iPhone prices across almost 50 countries spanning more than 10 years, and supports the hypothesis that the law of one price holds for some Apple products in both absolute and relative terms, particularly after controlling for transaction costs. This finding is attributable to the homogeneity of Apple products and the ease of accounting for transaction costs. The results suggest that Apple prices are better suited than often-used alternative price measures to investigate international parity conditions (e.g., the Big Mac Index and the consumer price index). The second panel dataset consists of weekly Apple iPad prices across 35 countries from 2016 through 2021. I use this dataset to evaluate the short-term, nonlinear adjustment behavior of real exchange rates with a range of nonlinear estimation techniques, including locally-weighted scatterplot smoothing, threshold regression models, and piecewise linear approaches. I find that the stochastic law of one price hypothesis is supported. Moreover, real exchange rate half-lives derived from Apple iPads are significantly shorter (estimated to be only a few weeks) than what is typically found in the literature for similar studies on the law of one price and purchasing power parity. Overall, my findings provide new insights into the dynamics of real exchange rates, highlighting the importance of using appropriate price measures and nonlinear estimation techniques.
Access to healthcare services in resource-constrained environments : evidence from Zimbabwe
(Stellenbosch : Stellenbosch University, 2023-12) Chari, Abigail; Burger, Ronelle; von Fintel, Dieter; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Access to healthcare services is fundamental to health and well-being, yet approximately half of the world’s population is unable to access healthcare services in times of need, which derails attainment of the Sustainable Development Goals. Weak access to healthcare services is a global health challenge, and is prevalent in Zimbabwe. This weak access is attributed to a fragile and fragmented health system, characterised by weak and ineffective service delivery. The fragmented health system affects particularly the already disadvantaged population through healthcare services that are either unaffordable or unavailable. As part of achieving the global Sustainable Development Goals, Zimbabwe aims to address inequality in and weak access to its healthcare services. This thesis examined fiscal incidence and inequality in access to healthcare services in Zimbabwe, using 2017 administrative health expenditure data from the Ministry of Health and Child Care and the Prices, Income, Consumption and Expenditure Survey of the Zimbabwe National Statistics Agency. Fiscal incidence was found to be, on average, pro-poor for Zimbabwe’s low-level facilities, and pro-rich for high-level facilities. It was further found that availability and affordability are, on average, pro-rich. Thus, differential access to health services between rural and urban areas was contributing to pro-rich inequality. Despite government healthcare expenditure, inequality in availability and affordability of healthcare services remains a challenge. Pockets of inequality persist in the healthcare sector, as the more affluent continue to benefit from well-resourced facilities. The government should, therefore, focus on poor and rural populations, who bear the brunt of weak access to healthcare services. While the effects and causes of drug stockouts are well articulated, there is a dearth of literature on the link between district-level drug stockouts and poverty. This thesis investigated the spatial inequality of drug stockouts and the relationship between drug stockouts and district poverty in Zimbabwe using data on district-level drug stockouts and poverty. The results showed that spatial inequality in drug stockouts and district poverty exists, while the relationship between drug stockouts and district poverty was weak and insignificant. Spatial interdependence in drug stockouts between districts also exists, indicating hot spots in drug stockouts. In times of drug stockouts, individuals tend to use alternatives to healthcare, some of which pose health dangers, and it is therefore important to improve drug availability in underserved districts by reducing spatial inequality and hot spots in drug stockouts. Given the negative effects of malaria on the vulnerable population, this thesis examined the association between malaria prophylaxis stockouts and birth- and maternal outcomes in Zimbabwe. Preventive efforts against malaria are crucial, given that pregnant women and neonates bear the greatest malaria burden. Therefore, it was hypothesised that women who do not receive malaria prophylaxis during pregnancy are at risk of malaria infections, which compromise birth weight and cause maternal anaemia. Combining the administrative data on malaria prophylaxis stockouts and 2015 nationally representative Demographic Health Survey data, the results showed that malaria prophylaxis stockouts occur frequently over time, and have a significant association with birth weight, especially for neonates with an average birth weight. Stockouts are associated with neonates tending towards the lower end of a normal birth weight, compromising their development. Thus, there is a need to invest in pharmaceutical information- and stock-ordering systems to improve drug availability at the point of care. In conclusion, there is inequality in healthcare services in Zimbabwe, which causes a heavy burden on poor and rural populations. These vulnerable populations have weak access to healthcare services, despite the government's efforts to improve service provision. This thesis sheds more light on access to healthcare services, to enhance relevant stakeholders’ understanding of this subject. To achieve an equitable society, policymakers should address the inequalities in access to healthcare services, together with the socio-demographic determinants of health. Policymakers should improve resource management, follow a needs-based approach, invest in pharmaceutical information systems and stock-ordering systems, and foster multi-stakeholder collaboration to ensure improved access to healthcare services.
Information asymmetry and the misalignment of incentives in the South African private healthcare sector
(Stellenbosch : Stellenbosch University, 2023-12) Vorster, Pamela Ann; Ronelle, Burger; Lungiswa, Nkonki; Helmuth, Reuter; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Healthcare markets are notorious for information asymmetry, which may result in the inefficient organisation of scarce resources. This dissertation examines information asymmetry occurring in both the demand for and supply of healthcare in the private sector of South Africa. This dissertation’s main contribution is of insights into inefficiencies within the private healthcare sector resulting from inherent information asymmetry in healthcare markets. These inefficiencies in the South African context make healthcare more expensive than it should be. The government has started implementing the National Health Insurance (NHI) which will require an efficient allocation of scarce resources. Research in South Africa is primarily focused on the public sector, although there are many lessons to learn from the private sector. The first essay discusses the presence of adverse selection in the market for health insurance in South Africa. It then examines individuals’ demand for insurance by identifying characteristics that influence their propensity to insure. The study found that some adverse selection may be built into the health insurance market. Individuals have a higher tendency to purchase insurance if they have a chronic condition or are pregnant. However, socio-economic factors appear to be major contributing factors to individuals’ insurance purchasing decisions. Once people join a medical scheme, they tend to maintain their membership. Therefore, measures to address wasteful healthcare spending that would decrease the overall cost of healthcare and, ultimately, the cost of insurance could sustainably increase the size of the risk pool. The second essay reports the results of a survey to investigate variations in treatment decisions among spine surgeons. It also identifies associations between surgeons’ characteristics and the treatment they select. The findings make a case for evaluating outcomes and costs to identify value-based care. Such research would assist countries seeking to contract with providers based on value. Greater uniformity in treatment and easy reporting of outcomes would provide guidance to patients. Further investment in training and participation in fellowship programmes may be necessary, along with greater dissemination of information from the literature. The third essay reports on a case study of rhizotomies to identify necessary conditions and red flags that could provide plausible signs of supplier-induced demand. A rhizotomy is a low-risk, discretionary procedure that is one of many treatments a patient can receive to address chronic back pain. The study used claims data from a large health insurer to investigate four broad themes: outcomes of the treatment, practitioner and patient characteristics, incidence and the total cost of trends, and practitioner landscape. This study found that some practitioners are likely to induce demand for rhizotomies. It illustrates how analysing claims data could assist in detecting supplier-induced demand. It indicates the need to pool claims data across the industry to provide funders with a useful tool to address such demand and overservicing, and to develop benefit options based on high-value treatment.
Socioeconomic status, economic insecurity and the obesity transition in South Africa : generational and life course aspects
(Stellenbosch : Stellenbosch University, 2023-03) Rich, Kate Tamarin; Von Fintel, Dieter; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Worldwide countries are undergoing the ‘nutrition transition’ – a shift towards diets high in saturated fat, sugar and cheap processed energy-dense foods, with a corresponding increase in rates of obesity. The rich tend to move through the transition ahead of the poor, and with this the burden of obesity tends to shift from the rich to the poor as countries develop, in a process that has been called the ‘obesity transition’. This dissertation explores several aspects of the social gradient in body weight in South Africa using the nationally representative National Income Dynamics Study (NIDS) data, proposing that changes across and between generations and over the life course may be one of the drivers of the shift from one stage of the obesity transition to the next. Chapter 2 explores the possibility that childhood socioeconomic status (SES) and intergenerational mobility may contribute to the reversal of the social gradient in body weight. I find that upward social mobility is associated with increased obesity risk in adulthood compared to individuals who maintained a stable high SES in childhood and adulthood. Furthermore, the social gradient in body mass index (BMI) is flatter among individuals from a high SES childhood background, and already appears to have reversed among women with a high childhood SES who also have a high SES in adulthood. These findings shed light on the future of the obesity transition in South Africa; they suggest that it may take more than one generation of sustained high SES – or perhaps of adequate childhood nutrition – before we see higher adult SES have a protective effect against obesity, and with it a plateau in obesity rates. Chapter 3 investigates generational aspects of the obesity transition, proposing that younger generations may be the first to see a reversal in the social gradient in body weight as they experience the benefits of upward intergenerational mobility and with it new circumstances and attitudes. I use a machine learning algorithm to find structural breaks in the social gradient in BMI by birth year. I find that the social gradient in BMI is flatter among younger cohorts of South African men, and find some indications that it is flatter among younger cohorts of women too, suggesting that the obesity transition may be driven in part by changes across generations. Chapter 4 asks whether economic insecurity is more strongly associated with body weight for those with higher levels of income, which yield increased access to excess energy. I find evidence that economic insecurity is more likely to be associated with higher BMI among higher-income women, while economic insecurity is not associated with higher BMI for men. These results suggest that, given continuing high rates of undernutrition in early life and rising living standards, obesity rates in South Africa are likely to continue to rise, particularly for those from low-SES childhood backgrounds. This calls for policies to attempt to reduce consumption of unhealthy foods, and to improve nutrition in childhood – particularly in the earliest years of life.
Measuring enrolment and support for children with disabilities at the school level
(Stellenbosch : Stellenbosch University, 2023-03) Deghaye, Nicola; van der Berg, Servaas; Hanass-Hancock, Jill; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: The overall purpose of this dissertation was to critically assess how disability inclusion in schools is and should be measured in South Africa and to develop and report on new measures of disability inclusion. Measurement of school-reported enrolment of learners with disabilities and inputs, processes and enablers of disability-inclusion in mainstream (ordinary) schools is considered. Despite the development of inclusive education policy in post-apartheid South Africa, implementation of disability inclusion in mainstream schools has been poorly documented and disability-related educational inequalities have persisted. Very few quantitative studies have addressed teacher training for inclusion, physical accessibility of schools, accessibility of learning materials or availability of disability support structures in mainstream schools in low- and middle-income countries (LMICs). This study develops new indicators of these aspects of disability inclusion and employs them in a nationally-representative school survey. A comprehensive analysis of school-reported enrolment of learners with disabilities was conducted to determine the reliability of disability-disaggregated enrolment data. The analysis demonstrates that school-level data on enrolment of learners with disabilities collected in annual surveys was inconsistent over time and incomplete and produce estimates that are much lower than rates of disability prevalence among learners estimated from household surveys. School reporting has, however, become more complete following the introduction of a learner-level Education Management Information System (EMIS). This study demonstrates that ordinary schools in South Africa have no financial incentive to enrol or report the presence of learners with disabilities. The importance of question wording when eliciting data on disability status has been demonstrated by previous research. This study demonstrates that the disability questions used in the EMIS in South Africa are not aligned with current education policy nor with the biopsychosocial model of disability. It recommends that the questions on disability status in EMIS are aligned with those used in the screening and identification processes used in schools since 2014. Multivariate analysis was used to show that schools in wealthier areas of South Africa are more likely to report enrolment of learners with disabilities than schools in more deprived areas. This suggests that schools in less wealthy areas experience greater difficulty identifying or reporting learner’ disability status. This has resulted in skewed reporting of disability-disaggregated enrolment by school wealth quintile. New (or improved) indicators of disability inclusion were developed and added to the School Monitoring Survey (SMS) 2017 (a nationally-representative sample of approximately 2,000 schools). The analysis was supplemented by a qualitative follow-up study examining ease of use of the teacher questionnaire. The improved indicators provide more comprehensive evidence on the proportion of schools that are physically accessible, have disability support structures in place, and where teachers have received training in inclusive education. These factors are critical in enabling ordinary schools to provide reasonable accommodation of learners’ individual needs. This study uses multivariate analysis to show that prior training is associated with improved teacher confidence in addressing learning barriers. This is the first study to use multivariate analysis of the SMS in relation to disability-inclusion. This study provides the first set of comparable nationally-representative data on disability inclusion at two time points. It shows that some progress has been made over time but that substantial provincial inequality across several indicators of disability inclusion remains. The performance of full-service schools is compared to that of ordinary schools in SMS 2017. A large, fairly-representative sample of full-service schools is shown to perform better than ordinary schools in various aspects of disability inclusion, but still fall short of the expectations in current guidelines. This study results in a much more comprehensive depiction of disability inclusion in ordinary schools than has been achieved by previous studies. It adds substantially to the body of evidence on operationalising the biopsychosocial model of disability in school indicators in middle-income countries.

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