The Impact of Disease-Specific Health Insurance Expansion 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.

• Emma Aguila, William H. Dow, Felipe Menares, Susan W. Parker, Jorge Peniche Soomin Ryu (2022) “Do Conditional Cash Transfers Reduce Hypertension?”

Progresa, an anti-poverty conditional cash transfer program, has been a model for similar programs in more than 60 countries. Numerous studies focused on schooling and nutritional and health status of children and adolescents or on 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 adults by gender two decades after the program began. Our results show that Progresa had significant benefits in terms of improved hypertension diagnosis and access to treatment among older adults. Cash transfer programs could complement healthcare access by providing the resources to buy medicines prescribed. However, we did not find changes on uncontrolled hypertension using systolic and diastolic measurements. The latter could be due to insufficient medication dosage titration or insufficient medication adherence.

• Emma Aguila, William H. Dow, Felipe Menares, Susan W. Parker, Jorge Peniche Soomin Ryu (2022) “Long Term Effects of Social Insurance on Adult Mortality: Evidence From the Progresa Program in Mexico.”

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.