Research

Abstract: Healthcare utilization among older people in developing countries is typically far below the level considered adequate in developed countries. This study investigates the effect of children's education on parental healthcare utilization in China. We exploit the change in children's education induced by the Compulsory Education Law (CEL) reform around 1986. We find that children's education reduces parents' outpatient care utilization, but increases their inpatient care utilization, self-treatment use, and dental care. These effects can partly be explained by knowledge transfer leading to an increasing knowledge of quality and price differentials between different treatments and awareness of chronic diseases—Indeed we also find that parents with higher-educated children are more likely to accurately report chronic diseases. Moreover, parents receive more monetary transfers from children and have more economic resources to afford health services if their children are better educated. In line with these mechanisms, we also find that children's education improves older parents' perceived chances to survive the next 10 years. 

Abstract: Nigeria’s May 2023 fuel-subsidy removal caused pump prices to triple overnight and generated larger price increases in communities farther from the fuel-supply network. We exploit this spatial gradient using a difference-in-differences design and instrument local petrol prices with predetermined depot distance interacted with the post-reform period to examine the short-run effects of higher fuel prices on inputs to early-life health. Using two rounds of the Demographic and Health Surveys, we show that households respond differently depending on whether care can be delayed. Scheduled care falls sharply: for a ten percent increase in the local price, children are 7.8 percentage points less likely to receive a required vaccine and 9.0 percentage points less likely to have it recorded as received on time. The number of antenatal visits and tests performed also declines. When illness cannot wait, parents are less likely to forgo care for their children but shift toward informal providers and pharmacies, with increased use of symptomatic-only treatments such as anti-motility for diarrhea. The likelihood of delivery with a skilled attendant falls as well. Even though richer households receive larger fuel-subsidy benefits, it is the poorer, rural, and low-facility-density households who show the largest reductions in health-care use after subsidy removal. Urban births show suggestive declines in neonatal mortality, consistent with improvements in urban air quality. So, compensation based only on foregone subsidy benefits may reach households least likely to suffer the adverse consequences.