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:
An emerging model in health care is the creation of public and private partnerships since the construction of physical infrastructure is costly. To increase healthcare access for low-income households, many state governments in India have introduced free health insurance programs, where qualifying families can access private hospitals for their tertiary care needs. We analyze one such pioneering social insurance scheme - the Rajiv Aarogyasri program (RA) introduced by the Government of Andhra Pradesh (AP) in 2007. We use policy discontinuities at state borders to identify the program’s effects on reproductive health behavior. Our results show a clear substitution effect of the relative price change – it significantly increased deliveries in private hospitals and reduced out-of-pocket costs. We do not find any significant impact on infant mortality and an increase in procedures like c-sections. There are two significances of our findings. First, many other states and even the national government emulated the model of forging public-private partnerships in India. Globally, governments also increasingly prefer to leverage private health infrastructure for subsidized health services. Second, the study offers caution that changing the financing model alone without expanding the health infrastructure may have a limited impact on outcomes and access for low-income families and may give rise to moral hazard behavior.
Demand for Health Insurance: Financial and Informational role of Informal Networks (with Tanika Chakraborty and Anirban Mukherjee) WP Link
Abstract:
In response to a remarkably high out of pocket (OOP) health expenditure in India, various state and the national governments in India, tried to introduce public health insurance programs. Despite being free, the take up and utilization of these programs remain low. In this paper, we seek to explain this puzzle by studying the role of informal networks in explaining insurance-adoption behavior in the context of the Arogyasri health insurance program introduced in the erstwhile state of Andhra Pradesh between 2007 and 2008. We use household panel data from the Young Lives Survey (YLS) to empirically study how the adoption of Arogyasri among poor households respond to their membership in informal networks. In this context, we differentiate between two types of network – financial network and information network. We find that adoption and utilization are significantly higher for households with access to informal financial networks. However, adoption and utilization increases much more for households outside informal networks, after they experience health shocks. Information sharing role of informal networks do not seem to affect the decision to adopt insurance. We also provide a simple theoretical framework to discuss the potential mechanisms underlying our empirical results.
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]