Research

The Political Economy of Democracies: Three Empirical Essays

My PhD dissertation, which includes the projects below as chapters and a general introduction, is available here.

Voter Disenchantment in the Aftermath of the 2005 EU Constitutional Referendum in France

In this paper, my co-authors and I investigate the electoral ramifications of ignoring the results of a popular referendum in France 2005. A majority of the electorate rejected the adoption of a proposed EU constitution, but, in seeming defiance of the popular vote, the French government subsequently proceeded to implement the core of the legislation without again consulting the public. We build a comprehensive, fine-grained dataset of nation-wide election results for more than 36,000 metropolitan French municipalities. Employing cross-sectional analysis for all national elections held in the decade after the referendum vote, we find that the strength of a municipality’s rejection of the EU constitution in 2005 is associated with (i) lower voter turnout, (ii) higher shares of blank votes, and (iii) larger gains for anti-system parties in subsequent elections. The findings are robust to various modelling choices and the inclusion of a large array of controls. The results indicate that bypassing a popular vote could entail protracted adverse effects for the quality of democratic participation and deliberation.

Publication available at Politics and Governance, 11(3);
Podcast on the paper

Doctor Turnover and Health Outcomes: Evidence from the Exit of Cuban Doctors in Brazil

w. Malte Becker, Thomas Hone, and Rudi Rocha

This paper studies the effects of a large-scale doctor exit and turnover on health care utilization, health outcomes, and health system inputs in Brazil. Due to political strife, over 9,000 Cuban primary care doctors had to leave the Brazilian health care system and had to be replaced.

We find that this unexpected massive exit and replacement of doctors resulted in a strong decrease in health care utilization in affected municipalities. However, while consultations on conditions requiring immediate care, such as infections, recovered as soon as the Cuban doctors were replaced, care on chronic diseases remained persistently reduced. The reduction in service utilization did not translate into any changes in health outcomes: patients continued to self-medicate and started to use Emergency Rooms instead of their primary care provider. Thus, while adaptation in local health systems and demand diversion helped mitigate turnover effects without major immediate adverse repercussions for population health, the large-scale turnover of primary care doctors spelt challenges for the detection and prevention of chronic diseases and the efficiency of long-term ongoing care in Brazil.

Working paper available;
Revise & Resubmit at the Journal of Health Economics

Access to Primary Care and Voting Outcomes: Evidence from an healthcare expansion program in Brazil

This paper investigates whether the "Programa Mais Médicos", a large-scale healthcare access program initiated by the Brazilian government in 2013, yielded electoral benefits for the party that implemented it. By the 2014 presidential elections, the program had brought over 14,000 primary care doctors to mostly remote and poor municipalities. Employing a matched difference-in-difference estimation, I find that in participating municipalities, the program increased the incumbent’s vote share by 0.9 percentage points in the first voting round of the 2014 presidential elections, up from an average vote share of 50 points in the reference elections of 2010. The impact on the second voting round is similar but extends to the 2018 elections. In the competitive Brazilian presidential elections, this represents a meaningful impact. However, the political impact varied across municipalities. I argue that the government targeted some municipalities due to equity concerns, aiming to improve health care access, but also targeted others with the strategic goal of improving re-election chances. The latter group consists of electorally competitive constituencies with little to no need for federal health care support. I find that municipalities targeted due to equity concerns increased their vote share by 2.1 and 1.2 points in the first and second round of the elections 2014, respectively. Electorally targeted municipalities saw no first-round gains but saw increases of 0.7 and 0.9 points in the second round of 2014 and 2018, respectively. The results suggest that improving healthcare access can lead to electoral rewards, especially where there is local need for the policy.

Draft available upon request

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