The causal effect of parental education on child mortality: evidence from the education reform in Vietnam (Lead author, with Dr. Minh Nguyen and Prof. Yoko Ibuka) (R&R, World Development). Presented at: the 3rd AWEHE, the 2021 JEA Autumn Meeting, the 2023 VEAM, Keio Applied Economics Workshop, Sophia Economics Seminar.

This paper examines the causal effects of paternal education on child mortality and potential underlying mechanisms. Using the 2009 Vietnam Population and Housing Census, we exploit the 1991 Universal Primary Education reform, which increased the duration of compulsory schooling from zero to 5 years, to implement a RD to address the endogeneity of paternal education to child mortality. The reform increased the average years of education for women and men by 0.55 and 0.53 years, respectively. Our IV results indicate that one additional year of maternal schooling induced by the education reform reduced child mortality by 29.4%. Increased paternal education also has a negative impact on child mortality, but the effect becomes insignificant when controlling for maternal education. Most of the improvement in child mortality were concentrated among women living in rural areas and in less developed regions. We also identify a number of pathways through which increased maternal education might affect child mortality, including increasing the likelihood of engaging in the labor force, having fewer children, delaying the onset of marriage, and having better prenatal care and health-seeking behaviors during and after pregnancy. 

The Intergenerational Health Effects of Child Marriage Bans (Lead author with Prof. Teresa Molina, Prof. Yoko Ibuka, and Prof. Rei Goto) Submitted to AEJ: Economic Policy. Presented at NBER, University of Connecticut, University of Hawaii at Manoa, 2023 JEA, Hitotsubashi University,  Sophia University, Essen Health Conference, and the 14th Japan-Taiwan-Korea Health Economics Association Joint Conference

Using a sample of over 200,000 women across 18 countries, we investigate the effects of child marriage bans on infant and under-5 mortality rates of the next generation. We exploit variation in mothers’ exposure to the ban across cohorts within each country, as well as subnational regional variation in “treatment intensity,” which we define based on the prevalence of and average age among child marriages prior to the ban. We find that child marriage bans reduced infant and under-5 mortality, with magnitudes of 14.3 and 19.9 percent corresponding to a one standard deviation change in treatment intensity, respectively. Reductions were driven by low-income countries and less wealthy households. Increases in age at first marriage and first birth, which may have led to better bargaining power and agency for these mothers during the prenatal and postnatal period, appear to be the main drivers of the mortality reductions documented.

The Impact of Intimate Partner Violence on Healthcare Utilization: Evidence From Vietnam (Lead author with Prof. Long Giang) - Under review by Review of Economics of the Household

This study investigated the relationship between intimate partner violence (IPV) and healthcare utilization among women in Vietnam, a topic which is largely unexplored in developing countries. Using an instrumental variable (IV) approach to address potential endogeneity concerns, we analyzed data from the National Survey on Domestic Violence against Women in Vietnam. Two-stage least squares regressions revealed that a one standard deviation increase in the IPV index was associated with a significant increase in the use of medication (36.5%) and outpatient visits (37.2%). Further analysis showed that these effects varied based on women’s and their husbands’ education, place of residence, and ethnicity. Mechanism analysis showed that IPV negatively impacted women’ health, potentially leading to increased healthcare utilization. These findings highlight the detrimental consequences of IPV on women’s health and healthcare utilization in the Vietnamese context, emphasizing the need for targeted interventions that address the diverse experiences of women and the social factors influencing healthcare access in the face of IPV.

The Intergenerational Effects of Intimate Partner Violence on Child Development (Lead author with Prof. Long Giang) - Under review by Feminist Economics

How children exposed to DV fare later in life has been an important area of research, since child health and development as child health and development are considered crucial indicators of societal well-being. We study the intergenerational effects of intimate partner violence (IPV) on child development in Vietnam. We contribute to the growing literature by examining the relationship between IPV and internalizing and externalizing behavior problems in Vietnamese children. Employing an instrumental variable approach to address potential endogeneity concerns, we analyzed data from the National Survey on Domestic Violence against Women. Two-stage least squares regressions show that a one standard deviation increase in the IPV index led to a 0.378-point increase in the child behavioral problem score. We further suggest that witnessing IPV and the negative impacts of IPV on women’s health may be pathways through which IPV affects children’s development. These findings highlight IPV as a major risk factor for negative child development outcomes, thus informing public health initiatives and social service interventions.

The Effects of Caring for Grandchildren on Health and Well-being of Grandparents: Evidence from Vietnam (Lead author with Prof. Long Giang) - Under review by Asian Social Work and Policy Review

To date, the effects of grandparenting on grandparents’ health and well-being do not reach the same conclusion and most of them have been conducted in developed countries. We add to this literature by examining the causal relationship between grandparenting and grandparents’ health and well-being in Vietnam, where the social norm and reciprocal relationships between adult children and their older parents are strong. Using instrumental variable estimations, we find that grandparenting care had positive effects on psychological well-being, life satisfaction, and self-rated health of grandparents. These results are robust to many robustness checks. Further exploring mechanisms underlying the effects reveals that improvements in memory and stronger social network were potential channels through which grandparenting might improve the health and well-being of grandparents. Our findings support the theory of role enhancement, suggesting that grandparents can have health and well-being benefits from grandparenting. Policies aiming at strengthening old age protection and family relationships should be advocated to sustain the subjective well-being of older adults.

Re-examining the Impact of Maternal Education on Child Mortality: Evidence From an Increase Tuition Fee Policy in Vietnam (Lead author) - Under review by International Journal of Educational Development

Reducing child mortality is highlighted as one of the most important indicators of Millennium Development Goals. The World Bank has stated that “there is no investment more effective for achieving development goals than educating girls”. Whether maternal education improves child health is an important policy question.  We revisit the paper by Phung-Nguyen (2023) (International Journal of Educational Development 96: 102704) who find that maternal education reduced neonatal, infant, and under-five mortality in Vietnam. She uses exposure to the introduction of tuition fee policy in1989 as an exogenous variation and using it to instrument for maternal education. We aimed to replicate her findings since the effect sizes of maternal education found in her paper are enormous. Using the same data and policy, we found no effect of maternal education on child mortality. Our result holds even when we use an alternative data for robustness checks.

Unmet Healthcare Needs Among Vietnamese Older People During the COVID-19: The Role of Social Support (Lead author with Prof. Long Giang, Dr. Thu Bui, Van Truong, and Anh To) - Under review by Asian Population Studies

This study aimed to examine the factors influencing subjective unmet needs (SUN) among older people in Vietnam during the COVID-19 pandemic, while offering novel insights into the potential mediating role of social support on the relationship between SUN and chronic diseases. Using the latest national survey on Vietnamese older people conducted in 2022 (N=2,140), we employed logistic regression models to identify determinants of SUN and explore how social support moderated the association between experiencing SUN and chronic diseases. We find that approximately 25% of Vietnamese older adults experienced SUN, with 21% forgoing medical treatment, 12% experiencing postponed services, and 2.4% denied care. Risk factors for experiencing SUN included older age, living alone, lack of healthcare insurance, and the presence of chronic diseases. Conversely, higher education, better wealth, and stronger social support acted as protective factors. Importantly, we found that social support, particularly from the community, significantly moderated the link between SUN and chronic diseases. 

Income-Related Inequalities in the top Common Chronic Diseases Among Vietnamese Older People (Lead author with Prof. Long Giang, Dr. Thu Bui, Van Truong, and Anh To) - Submitted to Journal of Population Studies

While multi-morbidity prevalence among older adults is high, research has primarily focused on its socioeconomic determinants, neglecting socioeconomic-related inequalities in the most common chronic diseases. This study aimed to address this gap by examining income-related inequalities in the top three chronic diseases (arthritis, blood pressure, and heart disease) among Vietnamese older adults. We used data from the 2019 Vietnam National Aging Survey (N=2,200) with concentration index (CI) and regression-based decomposition techniques. The prevalence of experiencing all three diseases was significantly higher among low-income individuals (CI=-0.069, p<0.05). Decomposition analysis revealed that income, self-rated health, and financial transfers from children were the main drivers of the observed inequality, contributing approximately 27.6%, 16.7%, and 14%, respectively. Findings of this study provides valuable evidence for policymakers aiming to address health inequalities in chronic diseases among older adults since such inequalities can lead to long-term challenges in accessing healthcare and potentially contribute to rising healthcare costs.

The effects of public health insurance on healthcare expenditures among older beneficiaries in Vietnam: RD-DID approach (Lead author with Prof. Rei Goto and Prof. Yoko Ibuka)

This paper evaluates the effects of changes in health insurance co-payment rates stipulated in the 2009 Health Insurance Law on healthcare expenditures and utilization by older pensioners in Vietnam. We adopt the most current appropriate econometric techniques in health economics to model healthcare data and then we exploit the enactment of the 2009 Law as a natural experiment to conduct a quasi-experiment study using RD-DID estimations. Using data from the Vietnam Household Living Standard Survey 2004-2014, we found that the effects of the 2009 Law, based on the best-fitting models for healthcare expenditure and utilization outcomes, were a significant increase in healthcare spending for both outpatient and the total healthcare expenditures, while the number of outpatient and inpatient visits were found to be significantly increased across levels of healthcare facilities. The results of this study suggest the ex-ante moral hazard in the use of healthcare whereby individuals who are offered a lower rate of co-payment tend to use more care.