Migration, Remittances, and Household Health: Evidence from South Africa Open Access
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This dissertation investigates the role of private transfers in influencing household consumption and the household's ability to smooth consumption in South Africa. It examines the general relationship between remittances and household health promoting expenditure patterns including health care utilization. It also examines remittances as a household coping strategy to insure income against a health shock. Given the multiple paths through which ill-health is a cause and a consequence of poverty, the ultimate goal of the research is to address the public policy implications of migration and remittances from both poverty and health perspectives. The need for better informed pro-poor health and social protection policies is relevant for a health system characterized by high levels of inequality in access, quality of care, and health care outcomes. The research takes advantage of panel data spanning from 1993 to 2004 from KwaZulu-Natal province to explore these questions in three independent but closely related papers. The first paper reviews the migration literature and proposes a framework for bringing together the remittances, health, and poverty streams in the literature. This paper also investigates the context of migration in South Africa, and the role of public transfers targeted to improve household welfare outcomes for the poorest households.The second paper explores whether remittance-receiving households consume more health promoting goods and have better health seeking behavior. The three main conclusions reported are: (1) remittance receiving households spend a larger budget share on food and health expenditures, (2) remittances enable poorer households to access better quality medical care, and (3) remittances may be a more efficient way than state transfers to target the financial needs of poorer households. The third paper analyzes whether remittance receiving households are better able to insure consumption against a health shock. In the absence of informal household safety nets from public or private transfers, health shocks reduce food consumption because households are unable to insure the economic cost of illness. The research shows that there is some evidence of state transfers crowding out private transfers, indicating that there is room for policy makers to improve social safety nets to enable poorer households to better insure consumption.