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  5. Health Disparities Caused by Public Policy
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Health Disparities Caused by Public Policy

Paper Session

Saturday, Jan. 6, 2024 8:00 AM - 10:00 AM (CST)

Grand Hyatt, Bonham B
Hosted By: American Economic Association
  • Chair: Benjamin Harrell, Trinity University

Effects of Physician Supply on Health Outcomes: Evidence from a Natural Experiment in Bangladesh

Md Amzad Hossain
,
University of Arkansas
Nirman Saha
,
University of Surrey

Abstract

While there has been a marked improvement in the health outcomes of the general population in developing countries in recent years, meeting people's health needs in remote and rural areas remains a key challenge. The shortage of qualified physicians in rural areas, a common feature in most low- and middle-income countries, has often been touted as one of the contributing factors. This paper assesses whether an increased supply of physicians in underdeveloped areas improves health outcomes and healthcare access. Under a unique intervention commenced in Bangladesh in 2013, the government recruited 6,000 physicians through a highly competitive exam, increasing the physicians' existing stocks by more than 25 percent. We use the variation generated by this program to show that the intervention improved several health outcomes and other healthcare access proxies. The number of outdoor patient visits increased by 20% of the baseline mean in a sub-district. We also observed a significant change in child delivery practice -- The likelihood that a child was born in a hospital or a clinic increased. The intervention also resulted in a significant change in health-seeking behavior--The probability of seeking treatment in a government facility increased, while that from unqualified practitioners decreased significantly. Using nationally representative survey data, we show that the intervention resulted in a 10 percent decline in the mortality rate. We also document heterogeneity in the treatment effect -- Poor people benefited more than the non-poor population regarding health-seeking behavior. We bolster our findings through an instrumental variable strategy using the number of vacant posts in the preceding year as an instrument. Our cost-effectiveness analysis suggests that the cost per life saved was $1200, suggesting that increasing physicians in rural lagging areas can be a cheap but effective intervention to promote better health outcomes in the developing world.

Love It or Leave It: Medicaid Expansion and Physician Location Choice

Xuechao Qian
,
Stanford University

Abstract

The health benefits of expansions in Medicaid coverage depend on whether insured patients can find providers. This paper investigates how one important group of providers, Obstetrician-Gynecologists (OB-GYNs) select their practice locations in response to expansions of Medicaid/CHIP coverage to mid-low income pregnant women. Expanding eligibility leads to an overall increase in the total supply of OB-GYNs at the county level, with an inflow of individual OB-GYNs to mid-low income counties. However, in state border counties, expanded eligibility reduces the number of OB-GYNs, as OB-GYNs move to the state with lower eligibility. In keeping with my model, while Medicaid/CHIP eligibility expansions on average increase physician supply, in certain cases, it can reduce access to care as physicians avoid low Medicaid reimbursement rates.

Revealed Comparative Disadvantage of Infants: Exposure to NAFTA and Birth Outcomes

Hamid Noghanibehambari
,
University of Wisconsin-Madison

Abstract

This paper examines the effects of trade liberalization under the North American Free Trade Agreement (NAFTA) on infants’ health outcomes in the US. I explore this question by implementing event studies and difference-in-difference regressions that compare birth outcomes of infants born in different years relative to NAFTA and localities with differential exposure to import competition. Using more than 88M birth records of Natality data, I find significant negative effects on a wide range of birth outcomes. The adverse effects are much larger for infants at the lower tails of birth weight and gestational age distribution. The heterogeneity analysis suggests larger effects for low-educated mothers and female infants. I show that these effects are not driven by selective fertility and preexisting trends in birth outcomes. Additional analyses using a wide range of alternative data sources suggest several potential pathways, including reductions in income-employment, decreases in housing wealth, lower health care utilization, lower health insurance use, and lower-quality health insurance. Finally, I provide discussions on the policy implications of these findings.

The Effects of Free Housing on Health, Wellbeing, and Healthcare Utilization

Valentina Duque
,
American University
Michael Gilraine
,
New York University
Diana Oquendo
,
University of the Andes
Fabio Sanchez
,
University of the Andes

Abstract

Using a nationwide experiment in Colombia that randomized over 30,000 housing units across highly disadvantaged groups, we investigate the effects of public housing on health and healthcare use. Our findings are as follows: i) using a survey on self-reported health outcomes, we find that lottery winners are less likely to experience health problems and more likely to enjoy mental wellbeing and life satisfaction years after the lottery; ii) leveraging administrative records on doctor visits, emergency room (ER) use, and hospitalizations we find significant declines in doctor visits due to respiratory conditions among children, fewer ER visits due to respiratory problems and infections among adults, and a large decline in the probability of death among the elderly. The program also reduced teen pregnancy. Our results shed light on the protective effect of improved housing conditions on health and wellbeing in developing countries.
JEL Classifications
  • I1 - Health