The Impact of Disease-Specific Health Insurance Reform on Mortality

with Pablo Muñoz

We study the impact of a healthcare reform that guaranteed universal access to care for a specific set of diseases. Using the universe of death and inpatient administrative records from Chile and a difference-in-difference research design, we show that deaths from the diseases covered by this reform decreased by 4.4%. The impact was larger for diseases that are amenable to health care, which decreased by 7.1%. The reform also increased surgeries by 16.3% and decreased in-hospital deaths by 6.9%. We also show that the reform has differential impacts across different groups by studying features to address mortality inequalities, e.g., we found that patients from public hospitals -the largest medical bed providers serving the most disadvantaged population- disproportionately benefited from this reform. Finally, longitudinal survey data and back-of-the-envelope calculations suggest that beneficiaries had more medical visits and lower out-of-pocket health expenditures, and that this reform increased life expectancy by 0.29 years. 

• Do Conditional Cash Transfers Reduce Hypertension?

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

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 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.