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on Health Economics |
| By: | Allcott, Hunt (New York University and NBER); Diamond, Rebecca (Stanford GSB and NBER); Dube, Jean-Pierre (Chicago Booth and NBER); Handbury, Jessie (Wharton and NBER); Rahkovsky, Ilya A. (U.S. Department of Agriculture); Schnell, Molly (Stanford) |
| Abstract: | We study the causes of “nutritional inequality†: why the wealthy eat more healthfully than the poor in the United States. Exploiting supermarket entry, household moves to healthier neighborhoods, and purchasing patterns among households with identical local supply, we reject that neighborhood environments contribute meaningfully to nutritional inequality. Using a structural demand model, we find that exposing low-income households to the same products and prices available to high-income households reduces nutritional inequality by only nine percent, while the remaining 91 percent is driven by differences in demand. These findings counter the common notion that policies to reduce supply inequities, such as “food deserts,†could play an important role in reducing nutritional inequality. By contrast, the structural results predict that means-tested subsidies for healthy food could eliminate nutritional inequality at a fiscal cost of about 15 percent of the annual budget for the U.S. Supplemental Nutrition Assistance Program. |
| JEL: | D12 I12 I14 L81 R20 |
| Date: | 2018–11 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:stabus:3750&r=all |
| By: | Neil M. Davies (University of Bristol); Matt Dickson (University of Bath); George Davey Smith (University of Bristol); Frank Windmeijer (University of Bristol); G.J. van den Berg |
| Abstract: | We compare estimates of the effects of education on health and health behaviour using two different instrumental variables in the UK Biobank data. One is based on a conventional natural experiment while the other, known as Mendelian randomization (MR), is based on genetic variants. The natural experiment exploits a compulsory schooling reform in the UK in 1972 which involved raising the minimum school leaving age (RoSLA). MR exploits perturbations of germline genetic variation associated with educational attainment, which occur at conception. It has been widely used in epidemiology and clinical sciences. Under monotonicity, each IV identifies a LATE, with potentially different sets of compliers. The RoSLA affected the amount of education for those at the lower end of the ability distribution whereas MR affects individuals across the entire distribution. We find that estimates using each approach are remarkably congruent for a wide range of health outcomes. Effect sizes of additional years of education thus seem to be similar across the education distribution. Our study corroborates the usefulness of MR as a source of instrumental variation in education. |
| Keywords: | returns to education, Health, instrumental variables, RoSLA, genomic confounding, LATE |
| JEL: | H52 I12 I21 I28 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2019-029&r=all |
| By: | Deschenes, Olivier (University of California, Santa Barbara); Wang, Huixia (Hunan University); Wang, Si (Hunan University); Zhang, Peng (Hong Kong Polytechnic University) |
| Abstract: | We provide the first study estimating the causal effect of air pollution on body weight. Using the China Health and Nutrition Survey, which provides detailed longitudinal health and socioeconomic information for 13,226 adult individuals over 1989-2011, we find significant positive effects of air pollution, instrumented by thermal inversions, on body mass index (BMI). Specifically, a 1 μg/m3 (1.59%) increase in average PM2.5 concentrations in the past 12 months increases BMI by 0.31%, and further increases the overweight and obesity rates by 0.89 and 0.19 percentage points, respectively. Our paper identifies a new cause of obesity, and sheds new light on the morbidity cost of air pollution. |
| Keywords: | air pollution, obesity, weight gain, China |
| JEL: | I12 I15 Q53 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12296&r=all |
| By: | Justine S. Hastings; Mark Howison; Sarah E. Inman |
| Abstract: | Misuse of prescription opioids is a leading cause of premature death in the United States. We use new state government administrative data and machine learning methods to examine whether the risk of future opioid dependence, abuse, or poisoning can be predicted in advance of an initial opioid prescription. Our models accurately predict these outcomes and identify particular prior non-opioid prescriptions, medical history, incarceration, and demographics as strong predictors. Using our model estimates, we simulate a hypothetical policy which restricts new opioid prescriptions to only those with low predicted risk. The policy’s potential benefits likely outweigh costs across demographic subgroups, even for lenient definitions of “high risk.” Our findings suggest new avenues for prevention using state administrative data, which could aid providers in making better, data-informed decisions when weighing the medical benefits of opioid therapy against the risks. |
| JEL: | D61 I1 I12 I18 Z18 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25791&r=all |
| By: | Fahad Alzahrani (Division of Resource Economics and Management, West Virginia University); Alan R. Collins (Division of Resource Economics and Management, West Virginia University); Elham Erfanian (Regional Research Institute, West Virginia University) |
| Abstract: | This paper explores the relationship between episodes of contaminated drinking water and health care expenditures in the United States. The analysis relies on panel data from the 48 contiguous states from 2000 to 2011. We use the population served by public water systems that violate health-based standards of the Safe Drinking Water Act as a proxy for contaminated drinking water. We estimate spatial and non-spatial models and control for factors that may affect per capita health care expenditures including variables that reflect air quality violations along with ability to pay plus demand for and supply of health care services. The results from a Spatial Durbin Model indicate that a 1% decrease in the percentage of population exposed to drinking water quality violations is associated with reductions in in-state and regional effects equal to 0.005% ($0.32) and 0.035% ($2.26) of per capita health care expenditures, respectively. Drinking water violations have a larger impact on expenditures than air quality violations (whose effects are not statistically different from zero). However, compared to other factors, such as Medicare enrollment and income, the impact of these violations on health care expenditures is relatively small. We find that regional health care expenditure impacts from drinking water violations are substantially greater than in-state impacts. Thus, a regional approach is recommended to addressing drinking water quality improvements. |
| Keywords: | Water Quality, Health Care Expenditures, Spatial Econometrics, Spillover Effects |
| JEL: | Q53 I11 C31 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:rri:wpaper:2019wp02&r=all |
| By: | Jinks, Lu (University of Illinois at Chicago); Kniesner, Thomas J. (Claremont Graduate University); Leeth, John D. (Bentley University); Lo Sasso, Anthony T. (University of Illinois at Chicago) |
| Abstract: | Texas is the only state that does not mandate that employers carry workers' compensation insurance (WC) coverage. We employ a quasi-experimental design paired with a novel machine learning approach to examine the effects of switching from traditional workers' compensation to a so-called non-subscription program in Texas. Specifically, we compare before and after effects of switching to non-subscription for employees in Texas to contemporaneously measured before and after differences for non-Texas-based employees. Importantly, we study large self-insured companies operating the same business in multiple states in the US; hence the non-Texas operations represent the control sites for the Texas treatment sites. The resulting difference-in-differences estimation technique allows us to control for any companywide factors that might be confounded with switching to non-subscription. Our empirical approach also controls for injury characteristics, employment characteristics, industry, and individual characteristics such as gender, age, number of dependents, and marital status. Outcomes include number of claims reported, medical expenditures, indemnity payments, time to return to work, likelihood of having permanent disability, likelihood of claim denial, and likelihood of litigation. The data include 25 switcher companies between the years 2004 and 2016, yielding 846,376 injury incidents. Regression findings suggest that indemnity, medical payments, and work-loss fall substantially. Claim denials increase and litigation falls. |
| Keywords: | workers' compensation insurance, non-subscription, difference-in-differences, triple differences, machine learning, PDS-LASSO |
| JEL: | C54 I13 J32 J38 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12290&r=all |
| By: | Cobb-Clark, Deborah A. (University of Sydney); Dahmann, Sarah C. (University of Sydney); Kettlewell, Nathan (University of Sydney) |
| Abstract: | Depression affects the way that people process information and make decisions, including those involving risk and uncertainty. Our objective is to analyze the way that depressive episodes shape risk preferences and risk-taking behaviors. We are the first to address this issue using large-scale, representative panel data that include both behavioral and stated risk preference measures and a theoretical framework that accounts for the multiple pathways through which depression affects risk-taking. We find no disparity in the behavioral risk preferences of the mentally well vs. depressed; yet depression is related to people's stated risk preferences and risk-taking behaviors in ways that are context-specific. Those who are likely to be experiencing a depressive episode report less willingness to take risks in general, but more willingness to take health risks, for example. We investigate these patterns by developing a conceptual model – informed by the psychological literature – that links depression to risk-taking behavior through the key elements of a standard intertemporal choice problem (e.g., time preferences, expectations, budget constraints). This motivates a mediation analysis in which we show that differences in risk-taking behavior are largely explained by depression-related disparities in behavioral traits such as locus of control, optimism and trust. Overall, we find that there is no overarching tendency for those who are depressive to engage in either more or less risk-taking. Instead, the decision-making context matters in ways that largely align with our theoretical expectations. |
| Keywords: | risk preferences, depression, mental health, risk-taking |
| JEL: | D91 I12 D14 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12285&r=all |
| By: | De Brouwer, Octave (Free University of Brussels); Leduc, Elisabeth (Free University of Brussels); Tojerow, Ilan (Free University of Brussels) |
| Abstract: | This paper investigates how the implementation of Job Search Monitoring (JSM) programs over the last two decades could have impacted the rise of disability rates in OECD countries. To do so, we use an RDD design to study how a JSM program that was implemented in 2006 in Belgium could have played a role not only in the transition to employment and inactivity but also in the transition to disability. The RDD exploits the fact that the program was only targeted at long‐term unemployed workers below the age of 50. Our results show that the JSM program has had a large impact on the transition rate from unemployment to disability and no impact on the transition rate to employment or inactivity. More precisely, individuals just below the age of 50 (the treatment group) are 1.43 percentage points (115%) more likely than individuals just above the age cut‐off (the control group) to enter into disability during the next quarter. Looking at heterogeneous effects, we find that the effect is above all important for women and more particularly for single‐women households. Overall, our study shows that JSM programs can have spillover effects on other social security branches, such as work disability. This is an important concern since it implies that JSM programs can push some individuals even further away from the labour market. Finally, our results show that the implementation of JSM could, constitute a viable explanation for the rise of the disability rate amongst unemployed workers. |
| Keywords: | disability, unemployment, Job Search Monitoring |
| JEL: | I13 J64 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12304&r=all |
| By: | de Elejalde, Ramiro (Universidad Alberto Hurtado); Giolito, Eugenio P. (Universidad Alberto Hurtado) |
| Abstract: | In this paper, we study the effect on cesarean rates of a policy change in Chile that decreased the cost of delivery at private hospitals for women with public health insurance. Using a difference-in-differences (DID) approach based on the eligibility conditions for this benefit, we find that in the first three years after the policy took effect, deliveries in private hospitals increased by 8.7 percentage points, while the probability of a C-section being performed increased by 4.6 percentage points, with negative impacts on average newborn weight and size at birth. We show that the probability of an early term birth in hospitals participating in the program is an increasing function of expected hospital demand at the time of the full-term due date. This suggests that in the absence of price incentives, hospitals use C-sections to smooth out demand over time to optimize the use of their resources. |
| Keywords: | health care, provider incentives, labor and delivery |
| JEL: | I11 I13 I18 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12297&r=all |
| By: | Allison Koenecke |
| Abstract: | We aim to determine whether a game-theoretic model between an insurer and a healthcare practice yields a predictive equilibrium that incentivizes either player to deviate from a fee-for-service to capitation payment system. Using United States data from various primary care surveys, we find that non-extreme equilibria (i.e., shares of patients, or shares of patient visits, seen under a fee-for-service payment system) can be derived from a Stackelberg game if insurers award a non-linear bonus to practices based on performance. Overall, both insurers and practices can be incentivized to embrace capitation payments somewhat, but potentially at the expense of practice performance. |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:1904.11604&r=all |
| By: | Hardardottir, Hjördis (Department of Economics, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Wengström, Erik (Department of Economics, Lund University) |
| Abstract: | When measuring inequality using conventional inequality measures, ethical assumptions about distributional preferences are often implicitly made. In this paper, we ask whether the ethical assumptions underlying the concentration index for income-related inequality in health and the Gini index for income inequality are supported in a representative sample of the Swedish population using an internet-based survey. We find that the median subject has preferences regarding income-related inequality in health that are in line with the ethical assumptions implied by the concentration index, but put higher weight on the poor than what is implied by the Gini index of income inequality. We find that women and individuals with a poorer health status put higher weight on the poor than men and healthier individuals. Ethically flexible inequality measures, such as the s-Gini index and the extended concentration index, imply that researchers have to choose from a toolbox of infinitely many inequality indices. The results of this paper are indicative of which indices (i.e. which parameter values) reflect the views of the population regarding how inequality should be defined. |
| Keywords: | Socioeconomic inequality in health; Income inequality; Extended concentration index; S-Gini index; Distributional preferences |
| JEL: | D31 D63 D90 I14 |
| Date: | 2019–04–26 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2019_007&r=all |
| By: | William H. Dow; Anna Godøy; Christopher A. Lowenstein; Michael Reich |
| Abstract: | Midlife mortality has risen steadily in the U.S. since the 1990s for non-Hispanic whites without a bachelor’s degree, and since 2013 for Hispanics and African-Americans who lack a bachelor’s degree. These increases largely reflect increased mortality from alcohol poisoning, drug overdose and suicide. We investigate whether these “deaths of despair” trends have been mitigated by two key policies aimed at raising incomes for low wage workers: the minimum wage and the earned income tax credit (EITC). To do so, we leverage state variation in policies over time to estimate difference-in-differences models of drug overdose deaths and suicides, using data on cause-specific mortality rates from 1999-2015. Our causal models find no significant effects of the minimum wage and EITC on drug-related mortality. However, higher minimum wages and EITCs significantly reduce non-drug suicides. A 10 percent increase in the minimum wage reduces non-drug suicides among adults with high school or less by 3.6 percent; a 10 percent increase in the EITC reduces suicides among this group by 5.5 percent. Our estimated models do not find significant effects for a college-educated placebo sample. Event-study models confirm parallel pre-trends, further supporting the validity of our causal research design. Our estimates suggest that increasing both the minimum wage and the EITC by 10 percent would likely prevent a combined total of around 1230 suicides each year. |
| JEL: | I1 I38 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25787&r=all |
| By: | Borella, Margherita (Università di Torino); De Nardi, Mariacristina (Federal Reserve Bank of Minneapolis); Yang, Fang (Louisiana State University) |
| Abstract: | White, non-college-educated Americans born in the 1960s face shorter life expectancies, higher medical expenses, and lower wages per unit of human capital compared with those born in the 1940s, and men's wages declined more than women's. After documenting these changes, we use a life-cycle model of couples and singles to evaluate their effects. The drop in wages depressed the labor supply of men and increased that of women, especially in married couples. Their shorter life expectancy reduced their retirement savings but the increase in out-of-pocket medical expenses increased them by more. Welfare losses, measured as a one-time asset compensation, are 12.5%, 8%, and 7.2% of the present discounted value of earnings for single men, couples, and single women, respectively. Lower wages explain 47-58% of these losses, shorter life expectancies 25-34%, and higher medical expenses account for the rest. |
| JEL: | E21 H31 |
| Date: | 2019–03–18 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedmoi:0019&r=all |
| By: | Böckerman, Petri (Labour Institute for Economic Research); Kortelainen, Mika (VATT, Helsinki); Laine, Liisa T. (University of Pennsylvania); Nurminen, Mikko (Turku School of Economics); Saxell, Tanja (VATT, Helsinki) |
| Abstract: | We exploit a large-scale natural experiment – the rollout of a nationwide electronic prescribing system in Finland – to study how digitization of prescriptions affects pharmaceutical use and health outcomes. We use comprehensive administrative data from patients treated with benzodiazepines, which are globally popular, effective but addictive psychotropic medications. We find no impact on benzodiazepine use on average, but among younger patients e-prescribing increases repeat prescription use. Younger patients' health outcomes do not improve but adverse outcomes, such as prescription drug abuse disorders and suicide attempts, increase dramatically. Improving access to medication through easier ordering may thus increase medication overuse. |
| Keywords: | health information technology, electronic prescribing, repeat prescriptions, inefficiency, medication overuse |
| JEL: | H51 H75 I12 I18 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12275&r=all |
| By: | KYZYMA Iryna; PI ALPERIN Maria Noel |
| Abstract: | Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), this paper identifies the education gradient in health and explores its underlying factors using a distributional approach. We start by constructing a separate health distribution for two education subgroups - the lower and higher educated - and compare the difference in the level of health between them at each point of the distribution. As a next step, we perform a semi-parametric decomposition exercise to explore which factors lie behind the observed health differential. In line with previous studies we find that, on average, higher educated people enjoy better health than those who are lower educated. We show, however, that the difference is not constant along the health distribution, with the gap being several times bigger at the top of the distribution than at its bottom. We also find that around 65 percent of the health gap between the lower and higher educated can be explained by the subgroup differences in demographic, labor market, and behavioral characteristics. |
| Keywords: | health inequality; educational gradient; health differential; distributional approach; decomposition |
| JEL: | D30 I10 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:irs:cepswp:2019-08&r=all |
| By: | Nadine Geiger; Sebastian Wichert |
| Abstract: | While World War II (WWII) is often employed as natural experiment to identify long-term effects of adverse early-life and prenatal conditions, little is known about the short-term effects. We estimate the short-term impact of the onset of WWII on newborn health using a unique data set of historical birth records ranging from December 1937 to September 1941. Furthermore we investigate the heterogeneity of this effect with respect to health at birth and for different social groups. To evaluate potential channels for our results, we explore how birth procedures changed. While we do not find any effects on birth weight and asphyxia, perinatal mortality increases immediately after the onset of WWII. The mortality effect is driven by live births and strongest for very low birth weight infants. A decline in quality of medical care due to the sudden conscription of trained physicians to military service is the most likely mechanism for our findings. |
| Keywords: | infant mortality, early-life health, health care supply |
| JEL: | I10 I18 N34 N44 |
| Date: | 2019 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_7593&r=all |
| By: | Huebener, Mathias (DIW Berlin) |
| Abstract: | This study analyses the relationship between life expectancy and parental education. It extends the previous literature that focused mostly on the relationship between individuals' own education and their life expectancy. Based on data from the German Socio-Economic Panel Study and survival analysis models, we show that maternal education is related to children's life expectancy - even after controlling for children's own level of education. This applies equally to women and men as well as to further life expectancies examined at age 35 to age 65. This pattern is more pronounced for younger cohorts. In most cases, the education of the father is not significantly related to children's life expectancy. The vocational training and the occupational position of the parents in childhood, which both correlate with household income, cannot explain the link. Children's health behaviour and the health accumulated over the life course appear as important channels. The findings imply that the link between education and life expectancy is substantially stronger and that returns to education are higher if intergenerational links are considered. |
| Keywords: | health inequality, returns to education, mortality, parental background, human capital, survival analysis |
| JEL: | I12 I14 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12316&r=all |
| By: | Coffey, Diane (rice Institute); Spears, Dean (University of Texas at Austin) |
| Abstract: | We document a novel fact about neonatal death, or death in the first month of life. Globally, neonatal mortality is disproportionately concentrated in India. We identify a large effect of birth order on neonatal mortality that is unique to India: later-born siblings have a steep survival advantage relative to the birth order gradient in other developing countries. We show that India's high prevalence of maternal undernutrition and its correlation with age and childbearing can explain this pattern. We find that Indian mothers exit the underweight body mass range at an internationally comparatively high rate as they progress through childbearing careers. |
| Keywords: | neonatal mortality, infant mortality, birth order, maternal nutrition, India |
| JEL: | O15 I15 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12288&r=all |
| By: | Zhang, Xin (Beijing Normal University); Chen, Xi (Yale University); Zhang, Xiaobo (Peking University) |
| Abstract: | This paper studies the impact of six main air pollutants on three key dimensions of subjective well-being (SWB) – life satisfaction, hedonic happiness and mental health. We match a nationally representative survey in China with local air quality and rich weather conditions according to the exact date and county of each interview. By making use of variations in exposures to air pollution across similar respondents living in the same county, we find that PM2.5 reduces hedonic happiness and increases the rate of depressive symptoms, but does not affect life satisfaction. Our results show that the benefits of reducing air pollution would be higher if the hidden costs of air pollution on SWB in China are taken into account. |
| Keywords: | life satisfaction, hedonic happiness, depressive symptoms, air pollution, China |
| JEL: | I31 Q51 Q53 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12313&r=all |
| By: | Giuliano Masiero (Department of Management, Information and Production Engineering, University of Bergamo, Italy; Institute of Economics (IdEP), Università della Svizzera italiana, Switzerland); Fabrizio Mazzonna (Institute of Economics (IdEP), Università della Svizzera italiana, Switzerland, and Munich Center for the Economics of Aging (MEA)); Sandro Steinbach (Department of Agricultural and Resource Economics, University of Connecticut, United States); Olaf Verbeek (Institute of Economics (IdEP), Università della Svizzera italiana, Switzerland) |
| Abstract: | Despite growing skepticism regarding the efficacy of antidepressants, global consumption is increasing at an unprecedented path with unknown implications for society. We estimate the causal effect of this increase on mental health outcomes using an IV strategy that exploits detailed drug sales data from Switzerland between 2002 and 2014. Our instrument, a modified version of the popular shift-share instrument, relies on the national growth in antidepressant sales for pharmaceutical companies (the shift) - mainly due to product innovation - and assigns it locally using regional non-antidepressant market shares. Our estimates show that an increase in antidepressants sales does not significantly affect suicide rates but cause an increase of hospital admissions for mental disorder and for depression. The causal effects prove to be resistant to several robustness checks. |
| Keywords: | Depression, Antidepressant treatment, Suicides, Mental health |
| JEL: | I12 I18 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:lug:wpidep:1902&r=all |
| By: | Rahman, Md. Sazedur; Rahman, Md. Saidur; Rahman, Md. Ashfikur |
| Abstract: | Background It is well established that improving human health has direct obvious payoff on enhancing life expectancy along with economic growth. Under-5 child mortality deliberately used to understand a countries overall public health status. In Bangladesh, child mortality remains a significant public health problem. Therefore, the chief intention of this undertaken study was to ascertain the best possible important factors of pre-school child mortality in Bangladesh. Methods This study was based on large dataset of Bangladesh Demographic and Health Survey, 2014 (BDHS-2014). Based on an extensive literature review thirteen covariates were selected. Chi-square test was accomplished to find out the association with under-5 deaths. The factors which achieved statistical significance (p |
| Keywords: | Determinants, Child, Mortality, Under-5, Infant, Bangladesh |
| JEL: | I1 I18 |
| Date: | 2019–01–10 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:93511&r=all |
| By: | Michael R.M. Abrigo (Philippines Institute for Development Studies); Timothy J. Halliday (University of Hawaii at Manoa UHERO, IZA); Teresa Molina (University of Hawaii at Manoa) |
| Abstract: | The Philippines expanded health insurance coverage of its senior citizens, aged 60 and older, in 2014. Employing data from two separate sources, we find that the expansion increased insurance coverage by approximately 16 percentage points. Instrumental variables estimates indicate that out-of-pocket medical expenditures more than doubled among the newly insured. We argue that this is most likely driven by an outward shift in the medical demand curve due to physician-induced demand. Quantile regression estimates indicate that these effects were the most pronounced among high utilizers. We show that the compliers, defined as those induced by the policy to obtain insurance, are disproportionately female and largely from the middle of the socioeconomic distribution. Finally, tests for selection indicate only moderate adverse selection into the treatment. |
| Keywords: | Immigration, Health Insurance, Cost Sharing, Medicaid, Insurance Exchange |
| JEL: | I10 I13 I14 |
| Date: | 2019–05 |
| URL: | http://d.repec.org/n?u=RePEc:hai:wpaper:201907&r=all |
| By: | Spears, Dean (University of Texas at Austin); Coffey, Diane (rice Institute); Behrman, Jere R. (University of Pennsylvania) |
| Abstract: | The poor state of child health in India has generated a number of puzzles that have received attention in the literature. A recent focus on birth order has produced contradictory results. Coffey and Spears (2019) document an early-life survival advantage in India accruing to later birth orders, which they interpret as the result of a pattern of improving maternal nutrition over mothers' childbearing careers. In apparent contrast, Jayachandran and Pande (2017) show, using the same set of demographic surveys, a disadvantage in child height for later birth orders in India relative to Africa's birth order gradient. They interpret this pattern as discrimination against later birth-order children in India. This paper resolves the apparent contradiction, showing how differing correlations between sibsize (a child's number of siblings) and household wellbeing can account for the empirical findings of both studies: A mother having higher fertility, rather than lower, implies more socioeconomic disadvantage within India than within Africa. Accounting for sibsize reverses the apparent Indian laterborn disadvantage in child height, reversing the interpretation of Jayachandran and Pande. In short, a child's sibsize (or, equivalently, its mother's fertility) is an omitted variable in Jayachandran and Pande's analysis of birth order effects. Resolving these puzzles is critical for human development policy to combat the enduring challenges of disproportionately high rates of stunting and neonatal death in India, where one-fifth of global births occur. |
| Keywords: | child height, birth order, India, DHS, high-dimensional fixed effects |
| JEL: | O15 I15 |
| Date: | 2019–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12289&r=all |
| By: | Dan Anderberg; Karlijn Marsink |
| Abstract: | Transfers motivated by altruism, norms of giving, and guilt play an important role in supporting individuals who suffer losses due to risk. We present empirical evidence from an artefactual field experiment in Ethiopia in which we introduce formal insurance in a setting where donors make redistributive transfers to anonymously paired recipients. We find that donors reduce their transfers to recipients who don’t take-up insurance, and that this effect is larger for donors who hold the ex ante belief that the recipient is more likely to take-up insurance. The findings are consistent with a model of a norm of giving where donors feel guilty for deviating from the norm. The feelings of guilt decline with the expected social distance, that is revealed by the recipients’ observable insurance uptake decisions. The model highlights how the introduction of formal insurance may erode norms of giving and lead vulnerable groups to face more volatile consumption. |
| Keywords: | formal insurance, transfers, norms of giving, guilt, social distance |
| JEL: | D64 D91 G22 O16 O17 |
| Date: | 2019 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_7596&r=all |