American University
Hamza_american_0008E_11976.pdf (6.58 MB)

Three Essays in Health and Education Economics in Egypt

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posted on 2023-09-07, 02:01 authored by Mariam Hamza

The global challenge of rising healthcare demand, coupled with an acute shortage of physicians, has become a pressing concern, particularly in Egypt. To address this issue, this dissertation comprises three essays that aim to tackle the shortage and maldistribution of physicians in Egypt.The first paper investigates the factors that make general practice jobs attractive to medical graduates in Cairo, Egypt, with the aim of providing policy recommendations for addressing the shortage of general physicians in the country. Addressing this shortage is particularly relevant given the current healthcare sector reforms that aim to improve efficiency by shifting towards a more primary-care-focused model. The paper focuses on the job attributes that influence medical students' decisions to specialize in certain areas of medicine and employs a discrete choice experiment to determine the relative importance of different job attributes. The results show that medical students in Ain Shams University prioritize job attributes such as lower working hours, training, and procedural opportunities over flexibility. Results suggest that financial and non-financial incentives could be effective in incentivizing general practice careers beyond higher salaries. Moreover, a standardized recruitment policy is likely to be successful, given the absence of heterogenous preferences across subgroups. The findings can inform policies aimed at addressing the shortage of healthcare workers, particularly in family medicine and primary care, by providing policymakers with insights into the preferences of medical students in Egypt.The second essay tackles the issue of the shortage of healthcare professionals in less urban areas, which poses a major challenge to achieving universal health coverage. The rural pipeline approach, which involves establishing more medical schools in underserved regions, is considered a promising strategy as graduates are more likely to practice in those areas. This paper examines the potential of this approach in Egypt, where 12 "people's universities" have been recently established. Using a discrete choice experiment, the study assesses the attitudes of medical students from two public universities located outside Cairo towards practicing in their home governorate after graduating from a local school. The findings indicate that students are more likely to stay and work in their home governorate after graduating. The study also highlights gender differences, as female students place greater importance on lower working hours and practicing in their home governorates. Financial incentives are found to play a critical role in motivating individuals to practice in underserved areas.Finally, the third paper evaluates the differences in academic performance between the mainstream program and the Extended Modular Program (EMP) at Ain Shams University's Faculty of Medicine in Egypt. The EMP was introduced as a fee-based program to increase the number of medical graduates without imposing a financial burden on the government or compromising the quality of education. The paper assesses the effectiveness of the EMP by comparing university exam scores and attendance of EMP students to those enrolled in the mainstream free program. To account for potential selection, the paper controls for students' background characteristics, including their high school program type and admission scores. The paper finds that students in the EMP program consistently outperform those in the mainstream program and have better attendance. However, the association becomes statistically insignificant when controlling for students' backgrounds, suggesting that the fees and lack of standardized entry exams induce selection bias rather than significantly impacting the quality of education.





Committee co-chairs: Jones, Kelly; Meurs, Mieke. Committee members: Omar, Ashraf; Lin, Tracy.




Degree Awarded: Ph.D. Economics. American University; Local identifier: local: Hamza_american_0008E_11976.pdf; Pagination: 120 pages

Degree grantor

American University. Department of Economics

Degree level

  • Doctoral

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