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Early-Life Medical Care and Human Capital Accumulation . IZA World of Labor, (December 2015) 217.
Ample empirical evidence links adverse conditions during early childhood (the period from conception to age ve) to worse health outcomes and lower academic achievement in adulthood. Can early-life medical care and public health interventions ameliorate these effects? Recent research suggests that both types of interventions may bene t not only child health but also long-term educational outcomes. In addition, early-life medical interventions may improve the educational outcomes of siblings. These ndings can be used to design policies that improve long- term outcomes and reduce economic inequality.
Saving Lives at Birth: The Impact of Homebirths on Infant Outcomes (with Mircea Trandafir, University of Southern Denmark and Reyn van Ewijk, University of Mainz). American Economic Journal: Applied Economics, 7:3 (July 2015) 28–50.
Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity in location of birth, we exploit the exogenous variation in distance from a mother's residence to the closest hospital. We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important channel contributing to these health gains.
Spillover Effects of Drug Safety Warnings on Preventive Health Care Use (with Chiara Orsini, LSE). B.E. Journal of Economic Analysis and Policy, 15:1 (January 2015), 179-208. (Earlier versions of this paper circulated as “Spillover Effects of Drug Safety Warnings on Health Behavior”)
We examine how new medical information on drug safety impacts preventive health care use. We exploit the release of the findings of the Women's Health Initiative Study (WHIS) -- the largest randomized controlled trial of women's health -- which demonstrated in 2002 the health risks associated with the long-term use of Hormone Replacement Therapy (HRT). We first show that, after the release of the WHIS findings, HRT use dropped sharply among post-menopausal women. We then estimate the spillover effects of the WHIS findings on preventive care by means of a difference-in-differences methodology comparing changes in preventive care use among 60 to 69 year-old women (who have high rates of HRT use) with the change among women aged 75 and above (who have much lower rates of HRT use). Using data from the Behavioral Risk Factor Surveillance System for the period 1998--2007, we find that women aged 60--69 had statistically and economically significant declines in their annual mammography checks, checkups, cholesterol checks and blood stool tests, when compared to older women.
Impact of Bilingual Education Programs on Limited English Proficient Students and Their Peers: Regression Discontinuity Evidence from Texas (with Aimee Chin, University of Houston and Scott Imberman, Michigan State University). Journal of Public Economics, 107 (November 2013), 63-78.
Texas requires a school district to offer bilingual education when its enrollment of limited English proficient (LEP) students in a particular elementary grade and language is twenty or higher. Using school panel data, we find a significant increase in the probability that a district provides bilingual education above this 20-student cutoff. Using this discontinuity as an instrument for district bilingual education provision, we find that providing bilingual education programs (relative to providing only English as a Second Language programs) does not significantly impact the standardized test scores of students with Spanish as their home language (comprised primarily of ever-LEP students). However, we find significant positive impacts on non-LEP students’ achievement, which indicates that education programs for LEP students have spillover effects to non-LEP students.
Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California, Journal of Health Economics, 31:4 (July 2012), 545-563. Mentioned in "The Economic Case For Health Care Reform" (Council of Economic Advisers).
In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome -- the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital nancial data from California (1999-2006). My results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection or unobserved trends and that they are robust to a host of specification checks. My results also indicate that the primary channel for the observed spillover effects is increased hospital uncompensated care costs. Although data limitations constrain my capacity to check how hospitals change their provision of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff.
Do Employment Subsidies Work? Evidence from Regionally Targeted Subsidies in Turkey (with Gordon Betcherman and Carmen Pages), Labour Economics, 17:4 (August 2010), 710-722.
This paper studies the effects on registered employment and number of registered establishments of two employment subsidy schemes in Turkey. We implement a difference-in-differences methodology to construct appropriate counterfactuals for the covered provinces. Our findings suggest that both subsidy programs did lead to significant net increases in registered jobs in eligible provinces (5%-13% for the first program and 11%-15% for the second). However, the cost of the actual job creation was high because of substantial deadweight losses, particularly for the first program (47% and 78%). Because of better design features, the second subsidy program had lower, though still significant, deadweight losses (27%-46%). Although constrained by data availability, the evidence suggests that the dominant effect of subsidies was to increase social security registration of firms and workers rather than boosting total employment and economic activity. This supports the theory that in countries with weak enforcement institutions, high labor taxes on low-wage workers may lead to substantial incentives for firms and workers to operate informally.
Heterogeneous Effects of Medical Interventions on the Health of Low-Risk Newborns (with Mircea Trandafir, University of Southern Denmark and Reyn van Ewijk, University of Mainz), Revised November 2016. NEW!
We investigate heterogeneity in the impact of early-life medical interventions on low- risk newborns’ health. A policy rule in The Netherlands creates large discontinuities in medical treatments at gestational week 37. Using a regression discontinuity design, we find no health benefits from additional treatments for average newborns. However, there is substantial heterogeneity in returns to treatments, with significant health benefits for newborns in the lowest income quartile and no benefits in higher income quartiles. We provide suggestive evidence that potential difficulties in risk screening among low- income women cause this heterogeneity. “Back-of-the-envelope” calculations suggest that providing additional treatments to all low-risk births as per the current policy rule is barely efficient, but a targeted policy focusing on low-income areas would be highly cost-effective.
Spillover Effects of Early-Life Medical Interventions (with Sanni Breining, Aarhus University, Marianne Simonsen, Aarhus University, Mircea Trandafir, University of Southern Denmark), Revised November 2016. IZA Working Paper No. 9086. NEW!
We investigate the spillover effects of early-life medical treatments on the siblings of treated children. We use a regression discontinuity design that exploits changes in medical treatments across the very low birth weight (VLBW) cutoff. Using administrative data from Denmark, we find that siblings of focal children who were slightly below the VLBW cutoff have higher 9th grade language and math test scores. Our results suggest that improved interactions within the family may be an important pathway behind the observed spillover effects.
The Miracle Drugs: Hormone Replacement Therapy and Labor Market Behavior of Middle Aged Women (with Chiara Orsini, LSE), Revised February 2014. IZA Working Paper No. 7993. Currently Revising.
In an aging society, determining which factors contribute to the employment of older individuals is increasingly important. We examine the impact of medical innovations on the employment of middle-aged women focusing on the specific case of Hormone Replacement Therapy (HRT), a common treatment for the alleviation of negative menopausal symptoms. HRT medications were among the most popular prescriptions in the United States until 2002 when the Women’s Health Initiative Study – the largest randomized control trial on women ever undertaken – documented the health risks associated with their long term use. We exploit the release of these findings within a Fixed Effect Instrumental Variable framework to address the endogeneity in HRT use. Our results indicate substantial benefits of HRT use to the short-term employment of middle-aged women.
Selected Work in Progress (all titles provisional)
Breast Cancer Treatment and Socioeconomic Outcomes of Treated Women and Their Families (funded through a DFF-Research 2 grant)
The Impact of Antidepressant Use on Socioeconomic Outcomes of Treated Individuals and Their Families (funded through a DFF-Research 1 grant; PI: Mircea Trandafir)
Effects of Language Proficiency on Health and Health Behavior (with Ana Ferrer, University of Waterloo and Mircea Trandafir, University of Southern Denmark)
Drug Decriminalization, Crime, and Infectious Diseases (with Julio Caceres-Delpiano, Universidad Carlos III de Madrid, Pedro Portugal, Banco de Portugal and NOVA School of Business and Economics, Ana Tavares, NOVA School of Business and Economics, Mircea Trandafir, University of Southern Denmark)
Autism and Assortative Mating (with Todd Elder, Michigan State University, Scott Imberman, Michigan State University, Judy Hellerstein, University of Maryland, Chiara Orsini, London School of Economics)
Permanent Working Papers
Returns to Childbirth Technologies: Evidence from Preterm Births (with Mircea Trandafir, University of Southern Denmark and Reyn van Ewijk, University of Mainz). IZA Working Paper No. 7834.
We investigate the impact of obstetrician supervision, as opposed to midwife supervision, on the health of low-risk newborns. We exploit a unique policy rule in the Netherlands that creates a large discontinuity in the probability of a low-risk birth being attended by an obstetrician at gestational week 37. Using a fuzzy regression discontinuity design, we consistently find no health benefits from obstetrician supervision, despite increased neonatal intensive care unit admission rates among births supervised by obstetricians. These results indicate potential cost savings from shifting supervision of low-risk deliveries, which represent the vast majority of all births, from obstetricians to midwives.