The Impact of Disease-Specific Health Insurance on Mortality

with Pablo Muñoz

We study the impact of a healthcare reform that standardized procedures across health providers to guarantee the timely coverage of a set of diseases. Using the universe of death records from Chile and a difference-in-differences research design, we show that mortality from the diseases covered by this reform decreased by 4.4%. The impact was larger on deaths from diseases more amenable to health care, which decreased by 7.1%. Among inpatients with covered diseases, the reform led to a 6.9% decrease in deaths and a 15% increase in surgeries. Our results suggest that this reform increased life expectancy by 0.39 years, creating benefits that largely outweighed its costs.

• Do Conditional Cash Transfers Reduce Hypertension?

with Emma Aguila, William H. Dow, Felipe Menares, Susan W. Parker, Jorge Peniche, and Soomin Ryu

Revision requested (second round) Economics and Human Biology

Progresa, an anti-poverty conditional cash transfer program, has been a model for similar programs in more than 60 countries. Numerous studies have found positive impacts on schooling, the nutritional and health status of children and adolescents, and household consumption. However, the effects on the health of older adult beneficiaries have been particularly understudied. In this paper we analyze the effects of Progresa on middle-aged and older adult health, focusing on a high prevalence chronic condition: hypertension. Our results show that Progresa had significant benefits in terms of improved hypertension diagnosis and use of treatment drugs. However, we did not find significant changes in uncontrolled hypertension as measured by systolic and diastolic blood pressure biomarkers in household survey data. Thus, while cash transfer programs may facilitate financial access to healthcare visits and the ability to buy prescribed medicines, by itself the program might not improve hypertension outcomes without complementary healthcare system follow-up to ensure dosage titration and medication adherence.

• Long Term Effects of Social Insurance on Adult Mortality: Evidence From the Progresa Program in Mexico

with Emma Aguila, William H. Dow, Felipe Menares, Susan W. Parker, Jorge Peniche, and Soomin Ryu 

Research on the mortality effects of income-support social insurance programs for older adults has generated conflicting results, but this work has primarily focused on short-run effects. We analyze the older adult mortality effects of Mexico’s pathbreaking Progresa conditional cash transfer social insurance program. We employ difference-in-differences models that exploit the geographic variation in program expansion to estimate lagged effects from one to ten years after increased coverage, focusing on high-poverty municipalities. We find that Progresa substantially reduced mortality in the short-run, particularly among females, with the largest effects after three years. All-cause mortality effects attenuated at increasing lag lengths, with no sustained benefit in ten-year lag models. Results varied by cause of death, though, with long-term benefits of earlier cash transfers sustained for female diabetes mortality even after a ten-year lag.

• Revisiting The Long-Term Effects of Education on Longevity in the U.S.: Evidence from Social Security Death Records Linked with 1940 Census 

We build on Lleras-Muney's (2005) seminal paper instrumenting compulsory schools laws (CSL) between 1915 and 1939 to provide causal evidence of the long-term effect of education on longevity in the U.S. We use the unique CenSoc individual-level data, which combines more than 6 million deaths from Social Security Administration records with the 1940 Census. The individual-level dataset allows us to overcome the first stage's weakness. We focus on old age mortality for both men and women cohorts born 1895-1920, using age at death as a proxy for longevity. We instrument years of education using the years of CSL ranging from 0 to 11, and we implement a recent DID estimator to address heterogeneous treatment effects across states and cohorts exposed to the CSLs that increase and decrease the years of mandatory schooling in the study period. We contribute to ongoing research on the causal relationship between education and mortality.