Skip to Main Navigation

Overuse and Underuse of Acute Healthcare: Evidence from Mali

April 12, 2021




  • Great strides have been made in preventive care in the last two decades. Today, better care for acute illness is central to further reducing mortality and morbidity. However, the process of accessing and using healthcare involves a series of complex decisions: families must determine whether an individual’s symptoms warrant a doctor visit, providers have to decide on diagnostic steps and treatment, and patients need to purchase medications and complete the treatment course. If this process does not effectively allocate treatment, underuse of care can coexist with overuse and misuse, imposing considerable burdens on resource-strapped healthcare systems.

    In this talk, World Bank economist Anja Sautmann will present three studies with patients of public health clinics in Mali. One examines the effect of healthcare subsidies and community health worker visits on the decision to seek care for children; a second asks to what degree providers are able to act as “gatekeepers” against patient demand for unnecessary malaria prescriptions; and a third shows different rates of antibiotics adherence in children by gender. Together they document varying degrees of underuse and overuse at all three decision margins for acute care. The talk will discuss the causes of this misallocation and potential levers for policy interventions, and point to current knowledge gaps.

  • Image

    Anja Sautmann (Speaker)

    Research Economist

    Anja Sautmann is a Research Economist in the World Bank's Development Research Group (Human Development Team). She is interested in how households and individuals make decisions, from healthcare for children to daily consumption to marriage, and how incentives and individual behavior shape optimal policy design. Before joining the World Bank, Anja was an Assistant Professor at Brown University (2010-2017) and the Director of Research, Education, and Training at the Abdul Latif Jameel Poverty Action Lab at MIT (2017-2020). She received her Ph.D. in Economics from New York University and her diploma in Economics from Ludwig Maximilians Universität in Munich, Germany. She is an affiliate of the CESifo research network.


    Gaston Sorgho (Discussant)

    Practice Manager, Health, Nutrition & Population

    A medical doctor by training, Gaston Sorgho received a Master of Public Health degree from the University of Amsterdam and a PhD in Public Health from the Harvard School of Public Health. He joined the World Bank in 1999 and has since worked all over Africa, spending several years as a Senior Public Health Specialist in the country offices of Cote d’Ivoire and Mali. From 2005 to 2009, he joined World Bank Institute (WBI) in Washington DC to teach courses on health sector reform and Results Based Financing in Africa, Europe and Asia. He was Country Manager in Mauritanie (2014-2016). Before joining the Bank he served more than 15 years at the Ministry of Health in Burkina Faso.


    Deon Filmer (Chair)

    Director of Research

    Deon Filmer is Director of the Research Group at the World Bank. He has previously served as Acting Research Manager in the Research Group, Co-Director of the World Development Report 2018: Learning to Realize Education’s Promise, and Lead Economist in the Human Development department of the Africa Region of the World Bank. He works on issues of human capital and skills, service delivery, and the impact of policies and programs to improve human development outcomes—with research spanning the areas of education, health, social protection, and poverty and inequality. He has published widely in refereed journals, including studies of the impact of demand-side programs on schooling and learning; the roles of poverty, gender, orphanhood, and disability in explaining education inequalities; and the determinants of effective service delivery.

  • The monthly Policy Research Talks showcase the latest findings of the World Bank’s research department, challenge and contribute to the institution’s intellectual climate, and re-examine conventional wisdom in current development theories and practice. These talks facilitate a dialogue between researchers and operational staff and inform World Bank operations both globally and within partner countries. Read More »