Do rural health worker incentive schemes work? Evidence from Thailand

This paper studies supply-side health interventions, which increased the monetary incentives and number of health professionals in the Deep South provinces of Thailand, and provides evidence on the effectiveness of provision of primary care providers on the health care utilization of the community. We use a difference-in-differences approach to estimate effects of this policy on child health by evaluating the probability of immunizations in the policy affected areas using two rounds of the Multiple Indicator Cluster Surveys (MICS). We find that after the policy implementation, there is a decrease in immunizations that are given to children within 2 months and 1 year of their date of birth between 6.8 to 17.9 percentage points, controlling for cohort specific time-invariant unobservables. However, we note an increase in BCG vaccinations that are administered at the time of birth. Event studies suggest no presence of pre-trends before the policy implementation. We also observe heterogeneity of effects along the dimensions of residence, ethnicity, and education of the caretaker with children belonging to rural areas, non-Thai ethnicity, and uneducated caretakers experiencing stronger effects. We investigate the quality of services as a mechanism to explain these findings using Thai Health and Welfare Surveys (HWS) and find a shift from small government facilities to large government facilities for in-patient services, indicating a decrease in demand due to lower quality.