Demand and Reimbursement Effects of Healthcare Reform: Health Care Utilization and Infant Mortality in Thailand

The Thai 30 Baht program was one of the largest health system reforms ever undertaken by a low-middle income country. In addition to lowering the cost of care for the previously uninsured in public facilities, it also entailed a fourfold increase in funding provided to hospitals to care for the poorest 30% of the population (who were already publicly insured). For the previously uninsured, we find that the 30 Baht program led to increased health care utilization, as well as a shift from private to public sources of care. But, we find a larger increase for the poor who were previously publicly insured, especially amongst infants and women of childbearing age. Using vital statistics records, we find that the increased access to healthcare by the publicly insured poor led to a reduction in their infant mortality of at least 6.5 per 1,000 births. This suggests significant improvements in infant mortality rates can be achieved through increased access to healthcare services for the poor and marginalized groups.

Essays on information and insurance markets

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 135-138).This thesis studies the impact of private information on the existence of insurance markets. In the first chapter, I study the case of insurance rejections. Across a wide set of non-group insurance markets, applicants are rejected based on observable, often high-risk, characteristics. I explore private information as a potential cause by developing and testing a model in which agents have private information about their risk. I derive a new no-trade result that can theoretically explain how private information could cause rejections. I use the no-trade condition to generate measures of the barrier to trade private information imposes. I develop a new empirical methodology to estimate these measures that uses subjective probability elicitations as noisy measures of agents' beliefs. I apply the approach to three non-group markets: long-term care (LTC), disability, and life insurance. Consistent with the predictions of the theory, in all three settings I find significant evidence of private information for those who would be rejected; I find that they have more private information than those who can purchase insurance; and I find that it is enough to cause a complete absence of trade. This presents the first empirical evidence that private information leads to a complete absence of trade. In the second chapter, I show that private information explains the absence of a private unemployment insurance market. I provide the empirical evidence that a private UI market would be afflicted by private information and suggest the amount of private information is sufficient to explain a complete absence of trade. I present evidence a private market would still not arise even if the government stopped providing unemployment benefits. Finally, in the third chapter I use the empirical and theoretical tools developed in the first chapter to explore the impact of an adjusted community rating policy that would force insurance companies to only price based on age. My results suggest such a policy would completely unravel the LTC insurance market. Not only would welfare not be improved for those who are currently rejected, but the regulation would prevent the healthy from being able to purchase long-term care insurance.by Nathaniel Hendren.Ph.D

The Great Equalizer: Health Care Access and Infant Mortality in

Abstract This paper analyzes Thailand's 2001 healthcare reform, "30 Baht". The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates

The Effects of Exposure to Better Neighborhoods on Children: New Evidence from the Moving to Opportunity Experiment

The Moving to Opportunity (MTO) experiment offered randomly selected families housing vouchers to move from high-poverty housing projects to lower-poverty neighborhoods. We analyze MTO's impacts on children's long-term outcomes using tax data. We find that moving to a lower-poverty neighborhood when young (before age 13) increases college attendance and earnings and reduces single parenthood rates. Moving as an adolescent has slightly negative impacts, perhaps because of disruption effects. The decline in the gains from moving with the age when children move suggests that the duration of exposure to better environments during childhood is an important determinant of children's long-term outcomes.Economic

The Great Equalizer: Health Care Access and Infant Mortality in

Abstract This paper analyzes Thailand's 2001 healthcare reform, "30 Baht". The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates

Where is the land of Opportunity? The Geography of Intergenerational Mobility in the United States

We use administrative records on the incomes of more than 40 million children and their parents to describe three features of intergenerational mobility in the United States. First, we characterize the joint distribution of parent and child income at the national level. The conditional expectation of child income given parent income is linear in percentile ranks. On average, a 10 percentile increase in parent income is associated with a 3.4 percentile increase in a child’s income. Second, intergenerational mobility varies substantially across areas within the United States. For example, the probability that a child reaches the top quintile of the national income distribution starting from a family in the bottom quintile is 4.4% in Charlotte but 12.9% in San Jose. Third, we explore the factors correlated with upward mobility. High mobility areas have (i) less residential segregation, (ii) less income inequality, (iii) better primary schools, (iv) greater social capital, and (v) greater family stability. Although our descriptive analysis does not identify the causal mechanisms that determine upward mobility, the publicly available statistics on intergenerational mobility developed here can facilitate research on such mechanisms.EconomicsStatistic

The Truth, the Whole Truth, and Nothing but the Truth: A Pragmatic Guide to Assessing Empirical Evaluations

An unsound claim can misdirect a field, encouraging the pursuit of unworthy ideas and the abandonment of promising ideas. An inadequate description of a claim can make it difficult to reason about the claim, for example to determine whether the claim is sound. Many practitioners will acknowledge the threat of un- sound claims or inadequate descriptions of claims to their field. We believe that this situation is exacerbated and even encouraged by the lack of a systematic approach to exploring, exposing, and addressing the source of unsound claims and poor exposition. This paper proposes a framework that identifies three sins of reasoning that lead to unsound claims and two sins of exposition that lead to poorly described claims. Sins of exposition obfuscate the objective of determining whether or not a claim is sound, while sins of reasoning lead directly to unsound claims. Our framework provides practitioners with a principled way of critiquing the integrity of their own work and the work of others. We hope that this will help individuals conduct better science and encourage a cultural shift in our research community to identify and promulgate sound claims