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The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated changes, is a factor in determining the ‘universal’ needs for health and well-being. Demography is concerned with the size, breakdown, age and gender structure and dynamics of a population. The same science, and its robust methodologies, is equally applicable to the demography of the health workforce itself. For example, a large percentage of the workforce close to retirement will impact availability, a geographically mobile workforce has implications for health coverage, and gender distribution in occupations may have implications for workforce acceptability and equity of opportunity. In a world with an overall shortage of health workers, and the expectation of increasing need as a result of both population growth in the global south and population ageing in the global north, studying and understanding demographic characteristics of the workforce can help with future planning. This paper discusses the dimensions of health worker demography and considers how demographic tools and techniques can be applied to the analysis of the health labour market. A conceptual framework is introduced as a step towards the application of demographic principles and techniques to health workforce analysis and planning exercises as countries work towards universal health coverage, the reduction of inequities and national development targets. Some illustrative data from Nepal and Finland are shown to illustrate the potential of this framework as a simple and effective contribution to health workforce planning.

This history of moral hazard in health insurance shows that this concept is different from how moral hazard is understood in economics outside of health. Health economists are divided on their understanding and conceptualization of moral hazard in health insurance and we show that these divisions can be organized along two main questions: one on the nature of demand for health care and one on the nature of demand for health insurance. The former revolves around the ability of consumers to make informed choices and, as a consequence, how we value the health care services that are consumed. The latter revolves around the idea that utility of consumption is significantly affected by changes in health status, and that health insurance might work, as a result, as an income transfer across states of the world rather than as protection against financial risk. Cette histoire du risque moral en assurance maladie montre que ce concept est différent du concept de risque moral utilisé en économie hors de l’économie de la santé. Les économistes de la santé sont en désaccord sur l’interprétation et la conceptualisation du risque moral en assurance maladie et nous montrons que ces désaccords peuvent s’organiser autour de deux questions principales : une sur la nature de la demande de soins médicaux et l’autre sur la nature de la demande d’assurance maladie. La première controverse porte sur la capacité des consommateurs à choisir de manière informée et, par conséquent, sur la façon dont nous valorisons les soins consommés. La seconde porte sur l’idée que l’utilité dérivée de la consommation est affectée significativement par les changements dans l’état de santé d’un individu, et que l’assurance maladie peut être par conséquent conçue comme un transfert de revenu entre états du monde, plutôt que comme une protection contre le risque financier.

This is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We apply several estimators to Indonesian household data to estimate the relationship between health insurance and the number of outpatient visits to public and private providers. Once endogeneity of insurance is taken into account, there is a 63 percent increase in the average number of public visits by the beneficiaries of mandatory insurance for civil servants. Individuals' decisions to make first contact with private providers is affected by private insurance membership. However, insurance status does not make any difference for the number of future outpatient visits.

Low-income countries are plagued by a high burden of preventable and curable disease as well as unmet need for healthcare, but detailed microeconomic evidence on the relationship between supply-side factors and service use is limited. Causality has rarely been assessed due to the challenges posed by the endogeneity of health service supply.In this study, using data from Mozambique, we investigate the effect of healthcare service availability, measured as the type of health facilities and their level of staffing and equipment, on the individual decision to seek care. We apply an instrumental variable approach to test for causality in the effect of staff and equipment availability on the decision to seek care and we explore heterogeneous effects based on the distance of households to the closest health facility.We find that living in the proximity of a health facility increases the probability of seeking care. A greater availability of referral health services in the locality has no significant effect on decision to seek care, while greater availability of staff and equipment increases the probability of seeking care when ill. Demand side barriers to health care use exist, but have a smaller impact when health care services are available within one hour walking distance.

In this paper, we examine the relationships between health care visits to general practitioners, public sector specialists and private sector specialists using data from Italy, which has a mixed public-private health care system. We develop a simultaneous equations model that allows for the discreteness of measures of utilization and estimate this model using maximum simulated likelihood. Once common unobserved heterogeneity is properly accounted for, general practitioners, public specialists and private specialists are found to be substitute sources of medical care. In contrast, a naive model finds they are complements.

Usage of health facilities in Ethiopia is among the lowest in the world; raising usage rates is probably critical for improving health outcomes. The government has diagnosed the principal problem as the lack of primary health facilities and is devoting a large share of the health budget to building more facilities. But household data suggest that usage of health facilities is sensitive not just to the distance to the nearest facility but also to the quality of health care provided. If the quality of weak facilities were raised to that currently provided by the majority of facilities in Ethiopia, usage would rise significantly. National data suggest that given the current density and quality of service provision, additional expenditure on improving the quality of service delivery will be more cost-effective than increasing the density of service provision. The budget allocation rule presented in the article can help local policymakers make decisions about how to allocate funds between improving the quality of care and decreasing the distance to the nearest health care facility.