Public Private Partnership Models in Social Health Insurance Schemes - Evidence from a Pioneering Program in India (with Tanika Chakraborty and Prabal De) WP Link
Abstract:
Establishment of public–private partnerships is an emerging model in health care delivery. This study evaluates a pioneering social health insurance program in India that enables eligible households to access private hospitals for tertiary care services free of cost, but does not build more facilities. Leveraging policy discontinuities at state borders, we identify the program’s causal effects on utilization of private facilities and associated out-of-pocket expenditures. The results indicate a pronounced substitution effect induced by relative price changes: the program substantially increases the incidence of deliveries in private hospitals while significantly reducing out-of-pocket spending. However, we find no statistically significant effects on fertility or a key health outcome, infant mortality.
Demand for Health Insurance: Financial and Informational role of Informal Networks (with Tanika Chakraborty and Anirban Mukherjee) WP Link
Abstract:
We study why free public health insurance in India exhibits persistently low utilisation despite high out of pocket health expenses. Using panel data from the Young Lives Survey and the rollout of the Arogyasri scheme in Andhra Pradesh, we distinguish the roles of informal financial and information networks in shaping adoption. Empirically, households embedded in financial networks show higher take-up and utilisation, while information networks have no effect. To explain this pattern, we develop a simple theoretical framework in which informal financial networks act as mutual insurance: because members bear each other’s uninsured losses, the network has an incentive to push all members to enrol when the expected cost of shocks exceeds enrolment transaction costs. This generates corner solutions for network members and interior solutions for non-members, consistent with observed bimodal take-up patterns. The model clarifies why financial—but not informational—ties complement public insurance and highlights community-based mechanisms for increasing adoption.
Should They Stay or Should They Go? Environmental Quality, Mobility, and Children’s Opportunities (with Ludovica Gazze and Lorenzo Neri)
Abstract:
Even low levels of pollution have overarching negative consequences for children's health and development. What's more, low-income and minority people are more likely to be exposed to, and affected by, pollution, suggesting that it might contribute to persistent inequality. Understanding the role of pollution in shaping neighbourhood composition and growth will be key to design policies that stimulate green and inclusive growth in the context of the UK government's levelling up agenda. This study will leverage a unique longitudinal data set following English students for circa twenty years to study the effects of short-term and cumulative pollution exposure on students' human capital and behaviour, including long-term college and labour market outcomes, as well as on families' residential mobility driven by changes in pollution. The study of short- and long-term outcomes of both stayers and movers will paint a full picture of the total effects of environmental quality on children exposed to pollution at different developmental stages, thus advancing the scholarship on the consequences of pollution and the importance of place.
Clear Skies, Clear Minds: Air Quality and Children's Welfare (with Ludovica Gazze and Lorenzo Neri)
Abstract:
Air pollution from the industry, transport and shipping sectors leads to over a thousand deaths in the UK yearly. Pollution has also consequences for children's wellbeing and learning, but these have not been studied in-depth to date. Understanding the impact of pollution exposure on children's wellbeing and academic performance is vital for children’s future success. We will study the impact of air pollution on children’s physical and mental health, as well as educational outcomes, in the short- and long-run. We will assess how these effects interact and reinforce each other. Finally, we will study how the quality of neighbourhood characteristics (e.g., schools, healthcare services) mediate these effects. We will combine large-scale data on air pollution sources with comprehensive data on education, physical, and mental health of all children in England since the early 2000s and use state-of-the-art methodologies to provide evidence on how changes in economic activity and transportation networks affect children’s health and human capital. This evidence will be key to understand how societal transformations, such as the net-zero agenda, are shaping the future of children across England through changes in local pollution.
Health Shocks and Educational Achievement: Mitigating role of Health Insurance (with Tanika Chakraborty) [Draft forthcoming]