Research
Peer-Reviewed Publications
"The Effect of Birth Timing Manipulation around Carnival on Birth Indicators in Brazil" (with N. Menezes Filho) XIII RIDGE FORUM - LACEA’s HEALTH ECONOMICS NETWORK 2021; SBE 2023
Health Economics (2024)
Available in Early View here
Featured at Agência FAPESP; BBC News; O Estado de S. Paulo; Veja; CNN Brasil; Folha; Revista Galileu; Gaucha ZH Zero Hora - Saúde; Estado de Minas; FAPESP na Mídia; Revista Crescer; Estadão; MSN; O Liberal; Terra; Prematuridade; Intramed
Abstract: This paper studies the patterns and consequences of birth timing manipulation around the carnival holiday in Brazil. We document how births are displaced around carnival and estimate the effect of displacement on birth indicators. We show that there is extensive birth timing manipulation in the form of both anticipation and postponement that results in a net increase in gestational length and reductions in neonatal and early neonatal mortality, driven by postponed births that would otherwise happen through scheduled c-sections. We also find a reduction in birthweight for high-risk births at the bottom of the weight distribution, driven by anticipation. Therefore, restrictions on usual delivery procedures due to the carnival holiday can be both beneficial and detrimental, raising a double-sided issue to be addressed by policymakers.
Keywords: birth timing manipulation, carnival holiday, gestational length, neonatal mortality, birthweight
"The Effects of a National Policy to Reduce C-sections in Brazil" (with N. Menezes Filho) LACEA LAMES | ANNUAL MEETING | BOGOTÁ 2021
Health Economics v. 32, n. 2 (2022)
Available here
Featured at Insper Conhecimento
Abstract: In this paper, we assess the effects of a national policy implemented in Brazil to avoid unnecessary cesareans. The policy has a supply-side component that prohibits elective c-sections before the 39th gestational week and a demand-side awareness component. Since the policy is not binding for cases with a strong medical c-section indication, we use births of breech- and transverse-positioned babies as a counterfactual for births of cephalic-positioned babies in a difference-in-differences framework. Our results reveal that the policy decreases the rate of c-sections by 1.6 percentage point, and slightly increases gestational time, birthweight, and first-minute APGAR scores. There is evidence that policy effectiveness is driven by its demand-side component.
Keywords: National Policy, Unnecessary Cesareans, Difference-in-Differences, Event-Study
"Passing through the supply chain: implications for market power" (with R. Moita & S. Sunao) EARIE 2019, SBE 2019
International Journal of Industrial Organization v. 79 (2021)
Available here
Featured at Revista Exame
Abstract: In this paper, we study the connection between pass-through and market power in the Brazilian Liquefied Petroleum Gas (LPG) industry. We use a state tax shock and apply a difference-in-differences strategy to estimate pass-through -- at different levels of the supply chain -- and an instrumented difference-in-differences strategy to estimate demand, and then feed a theoretical model to make inferences about conduct. We find an incomplete pass-through at the distribution and industry levels, and a more-than-complete one at the retail level. Furthermore, we estimate price-elasticity of demand to be greater than one. When we feed a theoretical model of pass-through under imperfect competition with these estimates, we obtain a high conduct at the industry level and an even higher one at the retail level alone. These results show that only considering the total industry pass-through may lead to hasty conclusions about market power. Besides contributing to the empirical literature that connects pass-through with market power, we contribute to on-going national discussions regarding competitiveness in the LPG industry.
Keywords: pass-through, market power, conduct, supply chain, gas industry, difference-in-differences
"Do extended school day programs affect performance in college admission tests?" (with D. Araújo, G. Bayma, L. Sampaio, & M. Mendonça) SBE 2019
Brazilian Review of Econometrics v. 40, n. 2 (2020)
Available here
Featured at Revista Exame
Abstract: We assess the effects of a Brazilian extended high school day program on college admission test scores. The program entails an increase in Math/Science and Language class time, and the introduction of extra-class activity time. We exploit variation in program implementation timing to apply a difference-in-differences strategy and an event-study approach. Results show positive large effects on test scores and suggest that these effects are likely driven by increased class and extra-class activity hours. Moreover, the program affects not only scores in subjects for which it contemplates increased class time, but also in Humanities. Finally, we are able to show that increased time dedicated to academic-related extra-class activities works as a multiplier of program effects. In fact, these additional hours spent in complementary activities make the magnitude of program effects double from 0.101-0.148 to 0.182-0.316 standard deviation.
Keywords: extended high school day program, difference-in-differences, event-study, college admission test scores
"Pandemics and Communication: An Experimental Assessment" (with S. Cabral)
Brazilian Journal of Public Administration v. 54, n. 4 (2020)
Available here
Featured at Revista Exame and UOL Notícias
Communication is a key factor in containing a pandemic. Fragmented information may affect people’s perceptions and behaviors, especially in times of governmental miscommunication, potentially jeopardizing efforts aimed at containing the spread of the disease. To test whether and how people have been sensitive to broken information during the COVID-19 pandemic in Brazil, we performed a randomized survey experiment on a sample of 571 respondents. We found that more pessimistic or more optimistic fragmented messages about the pandemic have no overall significant average effect on perceptions and planned behavior of the respondents. The exploratory analyses showed that particular sociodemographic groups are more sensitive to these fragmented messages. While less educated people react to more pessimistic messages with an increased likelihood to intensify prevention measures, people aged 60 or older – the high-risk group for COVID-19 complications – react to more optimistic messages with a reduced probability to intensify prevention measures. Besides providing insights to the public administration literature on disaster management, the results reinforce the need for governments to consistently centralize communication efforts to guarantee that people are equipped with complete and accurate information to form their perceptions and adequate their behaviors towards a health crisis.
Keywords: COVID-19; communication; survey experiment
Working Papers & Selected Work in Progress
"Prolonged Droughts and Education" (with I. Prenhaca)
Available here
Abstract: This paper examines the effects of an extended drought on education in a developing nation, highlighting how prolonged drought exposure influences both the supply and demand for education. We utilize weekly satellite data on vegetation health, temperature, and moisture to assess drought severity in the semi-arid region of Northeast Brazil during one of its most severe droughts in history. We employ a difference-indifferences approach that accounts for dynamic treatment effects to evaluate the cumulative impacts of weather shocks. On the supply side, we observe an 8% reduction in the number of public school teachers in affected municipalities. Additionally, municipalities experiencing more extreme drought months saw a 14% decrease in elementary school teachers over the years, with low-skilled teachers being the most impacted. The drought also led to school closures, particularly in areas lacking drinkable water. We do not observe similar effects in private schools. On the demand side, we find that droughts decreased student learning and increased grade progression in the long term, consistent with previous research findings.
Keywords: drought, economic development, natural experiment, climate change, education
"The economic cost of lung cancer in Brazil: A typical case of high productivity cost due to early mortality" (with V. Boarati, F. Bispo, M. Rocha, G. Rodrigues, & M. Penha)
Invitation to Revise & Resubmit (R&R) at World Medical and Health Policy - Wiley
Abstract: In this study, we use publicly available data from the Brazilian Ministry of Health and the National Agency for Supplementary Health, to perform a descriptive analysis and a population-based cost analysis, considering patients cared for by both the public and the private sectors, and considering not only direct but also indirect costs, related to loss in productivity. For matters of comparison and meaningful interpretation of the results, we also calculate the economic costs of breast and prostate cancer. Our results show that indirect costs of lung cancer, due to premature mortality, are disproportionately high, making evident the problem of late diagnosis and treatment of the disease. This evidence contributes to making the case for the implementation of a system of screening and early detection of lung cancer aimed at reducing premature deaths.
Keywords: economic cost, lung cancer, late diagnosis, screening and eatly detection
"Competing for change: The role of political contests in fostering local development" (with B. Cavani and P. Pichetti) - to be presented at LACEA LAMES | ANNUAL MEETING | BOGOTÁ 2023
Draft coming up soon
Abstract: We use a Regression Discontinuity design to assess the effects of political competition on a set of multidimensional development measures. Results show that, in municipalities eligible to have two-ballot-system mayoral elections -- which previous research has shown to increase political competition --, there is an increase of 7.1 percentage points in the share of the population employed in formal jobs (a 21% change), a decrease in general and juvenile homicide rates by 8.8 and 15.6 occurrences per 1,000 people (a 28% and a 21% change) respectively, and an increase in access to waste disposal services to the poor by 4.4 percentage points (a 5% change). Our results corroborate with previous evidence suggesting that political competition is important for the expansion of key public services, which can significantly contribute to the achievement of a municipality's development goals.
Keywords: Regression Discontinuity, two-ballot system, political competition, multidimensional development measures
Technical Notes & Policy Work
"O custo econômico do câncer de pulmão e a importância do rastreamento e diagnóstico precoce" (with V. Boarati, F. Bispo, M. Rocha, G. Rodrigues, and M. S. Penha)
Available here
Featured at Folha de S. Paulo & Insper Conhecimento
Other media mentions: Veja Saúde, Medicina S/A, Folha de S. Paulo, Galileu|Saúde, Portal do Holanda, Jornal de Brasilia, Brasil ao Minuto, Vitória News, Info4, MSN.com, Valor Econômico
Participation in events to communicate research findings: Fleury Seminar, Fórum DCNTs
Resumo:
Neste trabalho, buscamos mostrar que os custos econômicos do câncer de pulmão são relevantes já que a doença apresenta alta taxa de mortalidade em brasileiros em idade produtiva. Isso se deve em partes à falha do sistema de saúde de diagnosticar a doença em estágios iniciais, não permitindo um tratamento efetivo. A solução encontrada para esse problema em outros países se apoia em um sistema de rastreamento da população de risco e diagnóstico precoce, similar ao que já existe no Brasil para o câncer de mama. No entanto, para que se avance em um desenho e uma agenda de implementação de tal solução para o câncer de pulmão, é necessário que se considere aprendizados obtidos internacionalmente sobre as potenciais barreiras a serem enfrentadas e também o conhecimento de especialistas locais, capazes de traduzir essas barreiras para o contexto brasileiro e apontarem outras potenciais dificuldades a serem enfrentadas localmente. Tendo mapeado de forma organizada todo esse conhecimento, este trabalho traz recomendações para a implementação de um sistema de rastreamento e diagnóstico precoce do câncer de pulmão como política de saúde nacional. As recomendações levantadas envolvem dimensões de governança, força de trabalho, financiamento, critérios de elegibilidade, protocolos e monitoramento e avaliação. Um alinhamento entre todas as dimensões é importante para que o processo de implementação seja bem-sucedido.
"Os Determinantes da Realização de Cesáreas no Brasil" (with M. Mesquita de Magalhães, N. Menezes Filho, & B. Komatsu)
Available here
Abstract: This paper aims at understanding the determinants of the high c-section rate in Brazil. We assess the effect of the existence of a hospital with obstetric beds in the municipality of residence of mothers on their rate of c-section and the effect of the percentage of obstetric beds allocated to the public sector in a private hospital on the c-section rate of the hospital. To perform the analysis, we construct a panel of monthly data spanning from 2006 to 2016 at both the hospital level and the municipality level, as well as a panel containing all births given in hospitals that have obstetric beds in 2016. We find that the construction of a new hospital in a municipality reduces the c-section rate practiced by resident mothers and that the percentage of beds allocated to the public sector in private hospitals reduces the c-section rate practiced at the hospital. We also find that c-sections have a higher probability of happening on weekdays, in private hospitals with no beds allocated to the public sector, from white mothers, from married mothers, and from mothers with high levels of schooling, suggesting that non-medical factors affect the probability of a scheduled elective c-section.
Keywords: Health economics, Cesarean section (c-section), Public Policy
"Guide to the Assessment of Socio-Environmental Impact" - Insper Metricis
Available here
"A Lupa na Cidade - Painel de Indicadores de Desenvolvimento de Áreas Urbanas Vulneráveis" - Insper Metricis
Available here
Book Chapters