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Abstract

This dissertation is dedicated to study government programs from different perspectives. Chapter 1 presents evidence of measurement error in the report of program participation in Food Stamps and Public Assistance in different surveys of the U.S. Measurement error is often the largest source of bias in survey data, yet little is known about the determinants of such errors, making it difficult for data producers to reduce the extent of errors and for data users to assess the validity of analyses using the data. We study different causes of survey error using high quality validation data from three major surveys in the U.S. that are linked to administrative data on government transfers. The differences between survey and administrative records show that up to six out of ten cash welfare recipients are missed by surveys. We find that survey design and post-processing as well as misreporting by respondents affect survey errors systematically. Imputation for missing data induces substantial error. Our results on respondent behavior confirm several theories of misreporting, e.g. that errors are related to salience of receipt, respondent's degree of cooperation, forward and backward telescoping, event recall, and the stigma of reporting participation in social programs. Our results provide guidance on the conditions under which survey data are likely to be accurate and suggest different ways to control for survey errors. Chapter 2 investigates whether fixed costs of adjustment as opposed to low returns explain why better quality care practices diffuse slowly in the medical industry. Using a randomized field experiment, the results show that temporary financial incentives paid to health clinics for the early initiation of prenatal care nudged providers to test and develop new data driven strategies to locate and encourage likely pregnant women to seek care in the first trimester of pregnancy. These innovations raised the rate of early initiation of prenatal care by 34% while the incentives were being paid in the treatment period. Following health clinics over time the findings illustrate that this increase persisted for at least 24 months after the incentives ended. In the absence of incentives, it is in the clinics' interest to provide better prenatal care but learning and experimenting with new methods is too costly. The temporary incentives help to overcome initial costs and increase productivity in the long run. Despite the large increases in early initiation of prenatal care, there are no effects on health outcomes. Chapter 3 explores the effects of a conditional cash transfer program in Bolivia that pays mothers between $7 and $18 per health visit for prenatal checkups, skilled birth attendance and preventive health care checkups for children up to 24 months. Using municipal-level data from national health systems, the results show that the geographic variation in the penetration of the program coincided with a 12% reduction in the rate of stillbirths. Different tests assess that this relation is likely to be causal. This result is supported by a quasi-experimental analysis using data from a nationally representative household survey that shows that program beneficiaries experienced higher rates of early detection of pregnancies, total number of prenatal care visits, and a higher rate of skilled birth attendance and postpartum car. For children 0 to 2 years old, the program increased the number of checkups and reduced the prevalence of anemia, though we find no evidence of longer-term impacts on stunting or wasting. Since transfer amounts represent a small proportion of household consumption, we posit that health impacts are generated mainly through increased utilization of preventive healthcare rather than an income effect. The intervention is highly cost-effective, at $716.1 per DALY averted, equivalent to 29% of GDP per-capita.

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