Private Hospital Behavior Under Government Insurance: Evidence from Reimbursement Changes in India. Click on the link to access video.

Radhika Jain (University College London, UK)

Abstract: In a major shift away from direct public provision, LMICs around the world are expanding public insurance programs that contract the private sector to deliver health services. The success of these programs depends crucially on the behavior of private providers, particularly in lower-income contexts with limited regulatory capacity. Using over 1.6 million insurance claims and 20,000 patient surveys, and exploiting a policy-induced natural experiment, this paper provides new evidence on how private hospitals participate in government health insurance in India. It shows that: 1) Private hospitals engage in coding manipulation to increase revenues at government expense, and this is highly sensitive to changes in relative reimbursement rates of similar services. 2) Reimbursement increases also induce an increase in service volumes, indicating that treatment decisions are responsive to prices. 3) Hospitals charge patients for care that should be free under program rules. Raising reimbursement rates reduces these unauthorized charges significantly, but hospitals capture about half the rate increase overall, and all of it where they have market power. These findings highlight the ways in which private hospitals’ strategic behavior can undermine the effectiveness of public insurance, the critical role of prices in shaping hospital incentives, and the challenges of contracting the private sector for delivery of social services.

Making Bricks from Straw: Resources and Productivity in Health Care

Edward Okeke (RAND)

Cash Transfers and Child Nutrition: Evidence from the Philippines.

Eeshani Kandpal (Center for Global Development, US)

Abstract: This presentation will present evidence on the short-run and pilot medium-run effects of conditional cash transfers (CCTs) during the first 1000 days of a child's life, using data from the flagship cash transfer program in the Philippines. The presentation will summarize evidence from four papers--- three completed papers on the short-run effects of the cash transfer on beneficiary and non-beneficiary children at ages 0-36 months, and one ongoing medium-run follow up that assesses sustained impacts on the same children, but twelve years later when they are 12-15 years old.  All four papers leverage a randomized controlled trial conducted in 130 treated and control communities. The medium-run study is also able to assess the persistence of early-life stunting on a wide range of outcomes measured 12 years later. The outcomes assessed range from standard measures of child health and education, such as anthropometry, school enrollment and test scores, to innovative assessments of cognitive, socioemotional, and psychological wellbeing. The potential use of biomarker data, such as microbiomal and epigenetic analysis, to assess the persistence of early-life stunting will also be discussed. These findings contribute valuable evidence to inform policy decisions, emphasizing the lasting impact of early nutrition investments on human capital development.

Location: Griffin Hall, Room 3

Epidemiologic Transition and the Detection and Management of Chronic Diseases in Low- and Middle-Income Countries. Click on the link to access video. 

Grant Miller (Stanford U, US)

Abstract: As infectious and childbirth-related illnesses decline in low- and middle-income countries (and longevity converges with higher income countries), chronic diseases account for a growing share of disease burdens.  Chronic diseases can be more difficult to address than infectious ones: prevention can require substantial (if not daily) behavior change, treatment can be more expensive, and chronic diseases are generally incurable.  Early detection and management is a common strategy for controlling chronic diseases in many countries, but this approach requires increasing general contact with the health care system.  Even small barriers to care may therefore have bigger consequences than previously recognized.  To develop this idea, I give an example from Colombia, studying the entire formal sector workforce using health care utilization records linked to payroll data and vital statistics at the individual-month level over an 8-year period. Examining the role of higher (vs. lower) outpatient cost-sharing using a dynamic regression discontinuity model, our paper finds that higher outpatient cost-sharing initially reduces use of outpatient care, resulting in fewer diagnoses of common chronic diseases – and over time, increases the prevalence and severity of chronic diseases as well as use of inpatient care. Ultimately, higher outpatient cost-sharing meaningfully increases 8-year mortality. These findings are consistent with other new evidence on the importance of more frequent primary and preventive care. I conclude by discussing how these results might depend on the underlying quality of medical care (observing that they could be feasible even at varying levels of quality).

Location: Faculty Club

Fertility and the Education of African Parents and Children. Click on the link to access video. 

Tom Vogl (UCSD, US)

Abstract: Theories linking fertility decline to rising education among women and children have featured prominently in discussions of Africa's fertility transition, notable for its late timing and slow pace. Using data from 33 sub-Saharan African countries, this paper assesses how well place and cohort variation in fertility and education conforms to these theories. Across countries and subnational regions, lower fertility is associated with higher education in both women and children. Across female cohorts within a country or region, fertility decline is associated with a similarly large increase in women's education but no change in children's school enrollment and at most a small increase in children's grade attainment. Thus, while within-place variation corroborates past evidence that women's education drives fertility change in Africa, it suggests a more limited role for the interplay of the quality and quantity of children.

Health and Economic Growth: Reconciling the Micro and Macro Evidence. Click on the link to access video. 

Rainer Kotschy (Harvard U)

Abstract: Economists use micro-based and macro-based approaches to assess the macroeconomic return to population health. The macro-based approach tends to yield estimates that are either negative and close to zero or positive and an order of magnitude larger than the range of estimates derived from the micro-based approach. This presents a micro-macro puzzle regarding the macroeconomic return to health. We reconcile the two approaches by controlling for the indirect effects of health on income per capita, which macro-based approaches usually include but micro-based approaches deliberately omit when isolating the direct income effects of health. Our results show that the macroeconomic return to health lies in the range of plausible microeconomic estimates, demonstrating that both approaches are in fact consistent with one another.

Health and Development: A Macro Perspective
David Weil (Brown U)

Final Remarks
Susie Godlonton
Williams College

Location: Griffin Hall, Room 3

Closing
Quamrul Ashraf 
Chair of the Executive Committee for the Center for Development Economics
Halvorsen Professor for Distinguished Teaching and Research in Economics
Williams College

Location: Griffin Hall, Room 3