Spillover Effects in Healthcare Programs: Evidence on Social Norms and Information Sharing

Although cervical cancer is considered one of the most preventable types of cancer, mortality rates in many developing countries are extremely high. This paper exploits the randomized research design of a large welfare program - PROGRESA - to study the size and determinants of spillover effects in cervical cancer screening in rural Mexico. I find significant evidence of increased demand for Papanicolaou cervical cancer screening among women ineligible for the transfer, yet no evidence of similar externalities in non-gender specific tests, such as blood pressure and blood sugar checks. Different pieces of evidence from the randomized evaluation sample and the nationwide rollout are consistent with the hypothesis that the PROGRESA program has weakened the social norm related to husbands' opposition to screening of their wives by male doctors. I find no support for the hypothesis that the spillover effect is driven by higher levels of health information.Cervical cancer, Social norm, Information sharing, Progresa

Advantageous Selection in the Private Hospital Insurance Market in Europe: Evidence on the Role of Education and Cognitive Ability

I use microdata from the Survey of Health, Ageing and Retirement in Europe to study whether the cost of acquiring health information is an important determinant of the decision to buy private hospital health insurance for individuals aged 50+, in eight European countries. I first test whether, conditional on health insurance companies' risk assessments, individuals have residual private information on insurance determinants other than their risk type. My results show that there are individual characteristics, not observed by the insurers, that are positively correlated with hospital insurance coverage and negatively correlated with the ex post probability of requiring hospital treatment. However, this opposite association is significantly different from zero only in countries with low quality healthcare systems. I then provide evidence that education and cognitive ability act as substitutes for quality of health promotion in determining the propensity to take out a voluntary private hospital insurance.Health Insurance, Cognitive Ability, Healthcare Quality

Does Conditionality Matter for Adults' Health? Evidence from a Randomized Experiment

We present evidence on how the requirement to attend health and nutrition sessions affects the health behaviour of adults living in households targeted by a nutritional programme in rural Mexico. The evaluation sample of the Programa de Apoyo Alimentario (PAL) is unique in having four different treatment types, which are randomly assigned to four different groups of localities, with one group designated to receive transfers but without any requirement to attend health and nutrition courses. We find that attendance at educational sessions does not affect drinking and smoking behaviour, but significantly reduces the probability of having a large waist circumference among women. We provide evidence that attending health and nutrition related courses determines a large drop in the probability that adult women have excessive calorie intake. The results suggest that lack of information can explain, at least in part, the impressive rise in female obesity in developing countries.Adult Health, Conditional Cash Transfers, Information, PAL

Screening Tests, Information, and the Health-Education Gradient

The association between health outcomes and education – the health-education gradient - is widely documented but little is known about its source. Using microeconomic data on a sample of individuals aged 50+ in eight European countries, we find that education and cognitive skills (such as verbal fluency) are associated with a greater propensity for standard screening tests (mammography and colonoscopy). In order to study the role of information on the decision to screen, we test whether the health-education gradient varies with the quality of the information provided by the health care system, as proxied by the quality of the General Practitioner. Using an Instrumental Variable approach to control for the potential endogeneity of the GP quality score, we find evidence of a strong and significant complementarity between education and quality of primary care. We interpret this result as evidence that health-education gradient can be explained, at least in part, by the fact that better educated individuals are more able to process and internalize health related information as provided by GPs.Health, education, information, general practitioners

The Effect of Birthright Citizenship on Parental Integration Outcomes

This paper provides empirical evidence on whether child legal status at birth affects the level of cultural integration of immigrant parents with native community. We consider the 1999 reform of the German nationality law, which introduced birthright citizenship for children born in Germany to non-German citizen parents. Our results show that changes in the rules that regulate child citizenship have significantly increased parents’ propensity to establish contacts with German citizens and use the German language. The effect on parents’ integration varies according to the initial endowment of human capital and the level of integration in their local ethnic community.Citizenship Status, Migration, Integration

The Heterogeneous Effect of Information on Student Performance : Evidence from a Randomized Control Trial in Mexico

A randomized control trial was conducted to study whether providing 10th grade students with information about the returns to upper secondary and tertiary education, and a source of financial aid for tertiary education, can contribute to improve student performance. The study finds that the intervention had no effects on the probability of taking a 12th grade national standardized exam three years after, a proxy for on-time high school completion, but a positive and significant impact on learning outcomes and self-reported measures of effort. The effects are larger for girls and students from households with a relatively high income. These findings are consistent with a simple model where time discount determines the increase in effort and only students with adequate initial conditions are able to translate increased effort into better outcomes

High School Track Choice and Financial Constraints : Evidence from Urban Mexico

This paper examines the role of liquidity constraints in shaping curricular choices in upper secondary education. In the context of the centralized school assignment sys- tem in Mexico City, we study how a large household income shock affects sorting of relatively disadvantaged youth over high school tracks exploiting the discontinuity in the assignment of the welfare program, Oportunidades. The in-cash transfer is found to significantly increase the probability of selecting the vocational track as the most preferred option vis-a-vis other more academically-oriented education modalities. The observed change in stated preferences affects admission outcomes within the school assignment system, thereby suggesting the scope for longer term impacts on schooling and labor market trajectories

Enhancing Human Capital at Scale

A two-year randomized evaluation shows that the effectiveness of multi-tasking mentors on schooling outcomes crucially depends on their training. While a standard training modality in highly marginalized communities in Mexico generates null results, enhanced training yields sizable treatment effects on primary school children's cognitive, behavioral, and educational achievements. This difference cannot be explained by remedial educational activities or pedagogical support, but it can be reconciled with higher parental aspirations and investments. Evidence gathered on the subsequent national roll out of the intervention with enhanced training substantiates the external validity of our findings

Spillover Effects in Healthcare Programs: Evidence on Social Norms and Information Sharing

Although cervical cancer is considered one of the most preventable types of cancer, mortality rates in many developing countries are extremely high. This paper exploits the randomized research design of a large welfare program "PROGRESA" to study the existence of spillover effects in cervical cancer screening in rural Mexico. I find significant evidence of increased demand for Papanicolaou cervical cancer screening among women ineligible for the transfer, yet no evidence of similar externalities in non-gender specific tests, such as blood pressure and blood sugar checks. Different pieces of evidence from the evaluation sample and the nationwide rollout are consistent with the hypothesis that the PROGRESA program has weakened the social norm related to husbands' opposition to screening of their wives by male doctors. I find less evidence to support the hypothesis that the spillover effect is driven by higher levels of health information.

The heterogeneous effect of information on student performance: Evidence from a randomized control trial in Mexico

We use data from the randomized control trial of the Percepciones pilot to study whether providing 10th grade students with information about the average earnings associated with different educational attainments, life expectancy, and obtaining funding for higher education can contribute to improving student outcomes. We find that the intervention had no effects on a proxy for on-time high school completion, but a positive and significant impact on standardized test scores and self-reported measures of effort. The effects on standardized test scores are larger for girls and for students from households with relatively high incomes. We also find positive, but not statistically significant effects, on the probability of taking a university entry exam and of obtaining a high score in the exam