Working Paper Search
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Measuring progress towards universal health coverage: with an application to 24 developing countries
November 2015 - The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35–57 (Ethiopia, Guatemala, India, Indonesia and Vietnam).
Working Paper 7470
On the delegation of aid implementation to multilateral agencies
October 2015 - Some multilateral agencies implement aid projects in a broad range of sectors, with aid disbursements showing a strong overlap with those of bilateral donors. The question then arises of why do bilateral donors delegate sizable shares of their aid to non-specialized agencies for implementation? This paper develops a game theoretic model to explain this puzzle. Donors delegate aid implementation to the multilateral agency (ML) to strengthen the policy selectivity of aid, incentivizing policy improvements in recipient countries, in turn improving aid’s development effectiveness. Bilateral donors are better off delegating aid to ML even when they are purely altruistic but disagree on how aid should be distributed across recipients. Key for our result to hold is that ML searches some middle ground among disagreeing donors. Aid selectivity—in terms of both policy and poverty—emerges endogenously and is credible, as it is the solution to ML’s optimization problem. Moreover, the model shows that if one sufficiently large donor is policy selective in its aid allocations, there is no need for other donors to be policy selective.
Working Paper 7455
Which donors, which funds? the choice of multilateral funds by bilateral donors at the World Bank
October 2015 - The rapid growth of trust funds at multilateral development organizations has been widely neglected in the academic literature so far. Using a simple illustrative model, this paper examines the choice by sovereign donors among various trust fund options. The authors contend that the choice among the different trust funds involves a fundamental trade-off: larger funds provide donors with the benefit of burden sharing. Conversely, each donor can better assert its individual preferences in a fund with fewer other donors. The theoretical considerations yield testable implications on a range of factors affecting this fundamental tradeoff, most notably the area of intervention of the trust fund and competing domestic interests of donor countries. Using a sample of World Bank trust funds, the paper examines the participation decisions of Organisation for Economic Co-operation and Development/Development Assistance Committee donors over the past decade.
Working Paper 7441
The impact of violence on individual risk preferences: evidence from a natural experiment
October 2015 - This study estimates the impact of Kenya’s post-election violence on individual risk preferences. Because the crisis interrupted a longitudinal survey of more than five thousand Kenyan youth, this timing creates plausibly exogenous variation in exposure to civil conflict by the time of the survey. The study measures individual risk preferences using hypothetical lottery choice questions, which are validated by showing that they predict migration and entrepreneurship in the cross-section. The results indicate that the post-election violence sharply increased individual risk aversion. Immediately after the crisis, the fraction of subjects who are classified as either risk neutral or risk loving dropped by roughly 26 percent. The findings remain robust to an IV estimation strategy that exploits random assignment of respondents to waves of surveying.
Working Paper 7440
|The impact of secondary schooling in Kenya : a regression discontinuity analysis |
August 2015 - This paper estimates the impacts of secondary school on human capital, occupational choice, and fertility for young adults in Kenya. The probability of admission to government secondary school rises sharply at a score close to the national mean on a standardized 8th grade examination, permitting the estimation of causal effects of schooling in a regression discontinuity framework. The analysis combines administrative test score data with a recent survey of young adults to estimate these impacts. The results show that secondary schooling increases human capital, as measured by performance on cognitive tests included in the survey. For men, there is a drop in the probability of low-skill self-employment, as well as suggestive evidence of a rise in the probability of formal employment. The opportunity to attend secondary school also reduces teen pregnancy among women.
Working Paper 7384
Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India
June 2015 - This paper presents direct evidence on the quality of health care in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. Three main findings are reported. First, private providers are mostly unqualified, but they spent more time with patients and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy.
Working Paper 7334
Women Left Behind? Poverty and Headship in Africa
June 2015 - This paper is motivated by two stylized facts about poverty in Africa: female-headed households tend to be poorer, and poverty has been falling in the aggregate since the 1990s. These facts raise two questions: How have female-headed households fared? And what role have they played in Africa's impressive recent aggregate growth and poverty reduction? Using data covering the entire region, the paper reexamines the current prevalence and characteristics of female-headed households, and asks whether their prevalence has been rising over time, what factors have been associated with such changes since the mid-1990s, and whether poverty has fallen equi-proportionately for male- and female-headed households. Rising gross domestic product has dampened rising female headship.
Working Paper 7331
|Unbundling institutions for external finance : worldwide firm-level evidence |
June 2015 - The empirical literature on institutions and development has been challenged on grounds of reverse causality, measurement error in institutional indicators, and heterogeneity. This paper uses firm-level data across countries to confront these challenges. Instead of analyzing ultimate outcomes, such as income levels where institutional quality is likely endogenous, the focus is on firm-level external finance. Moreover, institutions are “unbundled” to explore how various types of institutions affect external finance differently. The paper documents that micro firms have significantly less access to external finance than small and medium firms.
Working Paper 7287
|Delivering education: a pragmatic framework for improving education in low-income countries|
May 2015 - Even as primary-school enrollments have increased in most low-income countries, levels of learning remain low and highly unequal. Responding to greater parental demand for quality, low-cost private schools have emerged as one of the fastest growing schooling options, challenging the monopoly of state-provided education and broadening the set of educational providers. Historically, the rise of private schooling is always deeply intertwined with debates around who chooses what schooling is about and who represents the interests of children. This time is no different.
Working Paper 7277
|World Bank policy lending and the quality of public sector governance |
May 2015 - This study investigates the impact of World Bank development policy lending for public sector governance on the quality of public sector management and institutions. The World Bank’s Country Policy and Institutional Assessments (CPIA) are used to measure the latter, the study considers only policy conditions targeted at improvements in those areas. The analysis uses a comprehensive country-year panel data set of aid receiving-countries and finds a significant and inverse U-shaped effect of public sector conditions on the quality of public sector governance. For most observed values in the data, the impact is positive, but it turns negative beyond a value of 80 conditions. At that point, the predicted CPIA score is about 0.25 point (0.3 standard deviation) higher than with zero conditions.
Working Paper 7267
|Information, knowledge and behavior: evaluating alternative methods of delivering school information to parents|
April 2015 - Improving education outcomes by disseminating information to parents and thereby encouraging them to become more actively engaged in school oversight is attractive, since it can be done relatively cheaply. This study evaluates the impact of alternative approaches to disseminating information about a school grants program in Indonesia on parents' knowledge about the program in general, knowledge about the implementation of the program in their child's school, and participation in school activities related to the program as well as beyond it. Not all dissemination approaches yielded impacts, and different modes of dissemination conveyed different types of information best, resulting in different impacts on behavior.
Working Paper 7233
|Report cards: the impact of providing school and child test scores on educational markets|
March 2015 - This paper studies study the impact of providing school and child test scores on subsequent test scores, prices, and enrollment in markets with multiple public and private providers. A randomly selected half of the sample villages (markets) received report cards. This increased test scores by 0.11 standard deviations, decreased private school fees by 17 percent, and increased primary enrollment by 4.5 percent. Heterogeneity in the treatment impact by initial school quality is consistent with canonical models of asymmetric information. Information provision facilitates better comparisons across providers, improves market efficiency and raises child welfare through higher test scores, higher enrollment, and lower fees.
Working Paper 7226
|Using lotteries to incentivize safer sexual behavior: evidence from a randomized controlled trial on HIV prevention|
March 2015 - Financial incentives are a promising HIV prevention strategy. This paper assesses the effect on HIV incidence of a lottery program in Lesotho with low expected payments but a chance to win a high prize conditional on negative test results for sexually transmitted infections. The intervention resulted in a 21.4 percent reduction in HIV incidence over two years. Lottery incentives appear to be particularly effective for individuals willing to take risks. This paper estimates a model linking sexual behavior to HIV incidence and finds that risk-loving individuals reduce the number of unprotected sexual acts by 0.3/month for every $1 increase in the expected prize.
Working Paper 7215
|Rewarding safer sex: conditional cash transfers for HIV/STI prevention|
November 2014 - Incentive-based policies have been shown to be powerful in many areas of behavior, but have rarely been tested in the sexual domain. The Rewarding Sexually Transmitted Infection Prevention and Control in Tanzania (RESPECT) study is a randomized controlled trial testing the hypothesis that a system of rapid feedback and positive reinforcement that uses cash as the primary incentive can be used to reduce risky sexual activity among young people, male and female, who are at high risk of HIV infection. The study enrolled 2,399 participants in 10 villages in rural southwest Tanzania.
Working Paper 7099
|Village Political Economy, Land Tenure Insecurity, and the Rural to Urban Migration Decision: Evidence from China|
November 2014 - This paper investigates the impact of land tenure insecurity on the migration decisions of China's rural residents. A simple model first frames the relationship among these variables and the probability that a reallocation of land will occur in the following year. After first demonstrating that a village leader's support for administrative land reallocation carries with it the risk of losing a future election, the paper exploits election-timing and village heterogeneity in lineage group composition and demographic change to identify the effect of land security.
Working Paper 7080
Exploiting externalities to estimate the long-term effects of early childhood deworming
October 2014 - This paper investigates whether a large-scale deworming intervention aimed at primary school pupils in western Kenya had long-term effects on young children in the region. The paper exploits positive externalities from the program to estimate the impact on younger children who did not receive treatment directly. Ten years after the intervention, large cognitive effects are found -- comparable to between 0.5 and 0.8 years of schooling -- for children who were less than one year old when their communities received mass deworming treatment. Because mass deworming was administered through schools, effects are estimated among children who were likely to have older siblings in schools receiving the treatment directly; in this subpopulation, effects are nearly twice as large.
Working Paper 7052
|Who Benefits from Government Health Spending and Why? A Global Assessment |
September 2014 - This paper uses a common household survey instrument and a common set of imputation assumptions to estimate the pro-poorness of government health expenditure across 69 countries at all levels of income. On average, government health expenditure emerges as significantly pro-rich, but there is heterogeneity across countries: in the majority, government health expenditure is neither pro-rich nor pro-poor, while in a small minority it is pro-rich, and in an even smaller minority it is pro-poor. Government health expenditure on contracted private facilities emerges as significantly pro-rich for all types of care, and in almost all Asian countries government health expenditure overall is significantly pro-rich.
Working Paper 7044
|Information is power: experimental evidence on the long-run impact of community based monitoring|
August 2014 - This paper presents the results of two field experiments on local accountability in primary health care in Uganda. Efforts to stimulate beneficiary control, coupled with the provision of report cards on staff performance, resulted in significant improvements in health care delivery and health outcomes in both the short and the longer run. Efforts to stimulate beneficiary control without providing information on performance had no impact on quality of care or health outcomes. The paper shows that informed users are more likely to identify and challenge (mis)behavior by providers and as a result turn their focus to issues that they can manage locally.
Working Paper 7015
|How useful is inequality of opportunity as a policy construct?|
July 2014 - The academic literature on equality of opportunity has burgeoned. The concepts and measures have begun to be used by policy institutions, including in specific sectors such as health and education. It is argued that one advantage of focusing on equality of opportunity is that policy makers are more responsive to that discourse than to equality of outcomes per se. This paper presents a critique of equality of opportunity in the policy context. Although the empirical analysis to which the literature has given rise is useful and is to be welcomed, current methods for quantifying and implementing the concept with a view to informing the policy discourse face a series of fundamental questions that remain unanswered. Without a full appreciation of these difficulties, the methods may prove to be misleading in the policy context.
Working Paper 6980
|Radio's impact on preferences for patronage benefits|
June 2014 - Citizens in developing countries support politicians who provide patronage or clientelist benefits, such as government jobs and gifts at the time of elections. Can access to mass media that broadcasts public interest messages shift citizens' preferences for such benefits? This paper examines the impact of community radio on responses to novel survey vignettes that make an explicit trade-off between political promises of jobs for a few versus public services for all. The impact of community radio is identified through a natural experiment in the media market in northern Benin, which yields exogenous variation in access across villages. Respondents in villages with greater radio access are less likely to express support for patronage jobs that come at the expense of public health or education.
Working Paper 6932
|World Bank lending and the quality of economic policy|
June 2014 - This study investigates the impact of World Bank development policy lending on the quality of economic policy. It finds that the quality of policy increases, but at a diminishing rate, with the cumulative number of policy loans. Similar results hold for the cumulative number of conditions attached to policy loans, although quadratic specifications indicate that additional conditions may even reduce the quality of policy beyond some point. The paper measures the quality of economic policy using the World Bank's Country Policy and Institutional Assessments of macro, debt, fiscal and structural policies, and considers only policy loans targeted at improvements in those areas.
Working Paper 6924
Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Trial
June 2014 - Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. This paper reports the results of a cluster randomized control trial in which 3,000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam’s government-run scheme and the benefits of health insurance; a voucher entitling eligible household members to 25 percent off their annual premium; and both.
Working Paper 6910
Progress Toward the Health MDGs: Are the poor Being Left Behind?
May 2014 - This paper looks at differential progress on the health Millennium Development Goals between the poor and better-off within countries. The findings are based on original analysis of 235 Demographic and Health Surveys and Multiple Indicator Cluster Surveys, spanning 64 developing countries over the period 1990-2011. Five health status indicators and seven intervention indicators are tracked for all the health Millennium Development Goals. In most countries, the poorest 40 percent have made faster progress than the richest 60 percent.
Working Paper 6894
|Effects of Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Cluster Randomized Trial|
May 2014 - A cluster randomized controlled trial was undertaken, testing two sets of interventions to encourage enrollment in the Philippines' Individual Payer Program. Of 243 municipalities, 179 were randomly assigned as intervention sites and 64 as controls. In early 2011, 2,950 families were interviewed; unenrolled Individual Payer Program-eligible families in intervention sites were given an information kit and a 50 percent premium subsidy until the end of 2011.
Working Paper 6893
|The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China: An Impact Evaluation|
May 2014 - In China, health care providers have traditionally been paid fee-for-service and overprescribing and high out-of-pocket spending are common. In this study, township health centers in two counties were assigned almost randomly to two groups: in one, fee-for-service was replaced by a global capitated budget; in the other, by a mix of global capitated budget and pay-for-performance.
Working Paper 6892
What a difference a state makes: health reform in Andhra Pradesh
May 2014 - In the mid-2000s, India began rolling out large-scale, publicly-financed health insurance schemes mostly targeting the poor. This paper describes and analyzes Andhra Pradesh's Aarogyasri scheme, which covers against the costs of around 900 high-cost procedures delivered in secondary and tertiary hospitals. Using a new household survey, the authors find that 80 percent of families are eligible, equal to about 68 million people, and 85 percent of these families know they are covered; only one-quarter, however, know that the benefit package is limited. The study finds that, contrary to the rules of the program, patients incur quite large out-of-pocket payments during inpatient episodes thought to be covered by Aarogyasri.
Working Paper 6883
|Son preference, fertility and family structure: evidence from reproductive behavior among Nigerian women|
May 2014 - Strong boy-bias and its consequences for young and unborn girls have been widely documented for Asia. This paper considers a country in Sub-Saharan Africa and finds that parental gender preferences do affect fertility behavior and shape traditional social institutions with negative effects on adult women's health and well-being. Using individual-level data for Nigeria, the paper shows that, compared to women with first-born sons, women with first-born daughters have (and desire) more children and are less likely to use contraceptives.
Working Paper 6869
|The effect of aid on growth: evidence from a quasi-experiment|
May 2014 - The literature on aid and growth has not found a convincing instrumental variable to identify the causal effects of aid. This paper exploits an instrumental variable based on the fact that since 1987, eligibility for aid from the International Development Association (IDA) has been based partly on whether or not a country is below a certain threshold of per capita income. The paper finds evidence that other donors tend to reinforce rather than compensate for reductions in IDA aid following threshold crossings.
Working Paper 6865
CATA Meets IMPOV: A Unified Approach to Measuring Financial Protection in Health
May 2014 - Up to now catastrophic and impoverishing payments have been seen as two alternative approaches to measuring financial protection in health. Building on the previous literature, the authors propose a unified methodology in which impoverishing and catastrophic payments are mutually exclusive outcomes. They achieve this by expressing out-of-pocket payments as a ratio of 'discretionary' consumption, defined as the amount by which total consumption (gross of out-of-pocket payments) exceeds the poverty line.
Working Paper 6861
|Why are adult women missing? son preference and maternal survival in India|
March 2014 - This paper is the first to show that excess mortality among adult women can be partly explained by strong preference for male children, the same cultural norm widely known to cause excess mortality before birth or at young ages. Using pooled individual-level data for India, the paper compares the age structure and anemia status of women by the sex of their first-born and uncovers several new findings. First, the share of living women with a first-born girl is a decreasing function of the women's age at the time of the survey. Second, while there are no systematic differences at the time of birth, women with a first-born girl are significantly more likely to develop anemia when young and these differences disappear for older women.
Working Paper 6802
|HIV Testing, Behavior Change, and the Transition to Adulthood in Malawi|
March 2014 - For young adults living in countries with AIDS epidemics, getting an HIV test may influence near-term decisions, such as when to leave school, when to marry, and when to have a first child. These behaviors, which define the transition from adolescence to adulthood, have long-term implications on well-being and directly affect a person's risk of contracting HIV. Using an experimental design embedded in a panel survey from Malawi, this study assesses the impact of voluntary counseling and testing of young adults for HIV on these decisions. The results show negligible intent-to-treat effect of HIV testing on behaviors. There is some suggestive evidence on differential response by wealth and by prior beliefs about one's status.
Working Paper 6825
Academic Peer Effects with Different Group Assignment Policies: Residential Tracking versus Random Assignment
February 2014 - This paper studies the relative academic performance of students tracked or randomly assigned to South African university dormitories. Tracked or streamed assignment creates dormitories where all students obtained similar scores on high school graduation examinations. Random assignment creates dormitories that are approximately representative of the population of students. Tracking lowers students' mean grades in their first year of university and increases the variance or inequality of grades. This result is driven by a large negative effect of tracking on low-scoring students' grades and a near-zero effect on high-scoring students' grades.
Working Paper 6787
|Coping with Risk: The Effects of Shocks on Reproductive Health and Transactional Sex in Rural Tanzania|
January 2014 - Transactional sex is believed to be an important risk-coping mechanism for women in Sub-Saharan Africa and a leading contributor to the HIV/AIDS epidemic. This paper uses data from a panel of women in rural Tanzania whose primary occupation is agriculture. The analysis finds that following a negative shock (such as food insecurity), unmarried women are about three times more likely to have been paid for sex. Regardless of marital status, after a shock women have more unprotected sex and are 36 percent more likely to have a sexually transmitted infection. These empirical findings support the claims that transactional sex is not confined to commercial sex workers and that frequently experienced shocks, such as food insecurity, may lead women to engage in transactional sex as a risk-coping behavior.
Working Paper 6751
|Incentives and teacher effort: further evidence from a developing country|
November 2013 - Few would contest that teachers are a very important determinant of whether students learn in school. Yet, in the face of compelling evidence that many students are not learning what they are expected to learn, how to improve teacher performance has been the focus of much policy debate in rich and poor countries. This paper examines how incentives, both pecuniary and non-pecuniary, influence teacher effort. Using school survey data from Lao PDR, it estimates new measures of teacher effort, including the number of hours that teachers spend preparing for classes and teacher provision of private tutoring classes outside class hours. The estimation results indicate that teachers increase effort in response to non-pecuniary incentives, such as greater teacher autonomy over teaching materials, and monitoring mechanism, such as the existence of an active parent-teacher association and the ability of school principals to dismiss teachers.
Working Paper 6694
|Getting Incentives Right: An Impact Evaluation of District Hospital Capitation Payment in Vietnam|
November 2013 - This paper evaluates the impact of a shift by Vietnam's social health insurance agency from reimbursing hospitals on a fee-for-service basis to making a capitation payment to the district hospital where the enrollee lives. The analysis uses panel data on hospitals over the period 2005-2011 and multiple cross-section data sets from the Vietnam Household Living Standards Surveys to estimate impacts on efficiency, quality, and equity. The paper finds that capitation increases hospitals' efficiency, as measured by recurrent expenditure and drug expenditure per case, but has no effect on surgery complication rates or in-hospital deaths. In response to the shift to capitation, hospitals scaled down service provision to the insured and increased provision to the uninsured (who continue to pay out-of-pocket on a fee-for-service basis).
Working Paper 6709
Admission is free only if your dad is rich! distributional effects of corruption in schools in developing countries
October 2013 - In the standard model of corruption, the rich are more likely to pay bribes for their children's education, reflecting higher ability to pay. This prediction is, however, driven by the assumption that the probability of punishment for bribe-taking is invariant across households. In many developing countries lacking in rule of law, this assumption is untenable, because the enforcement of law is not impersonal or unbiased and the poor have little bargaining power. In a more realistic model where the probability of punishment depends on the household's economic status, bribes are likely to be regressive, both at the extensive and intensive margins. Using rainfall variations as an instrument for household income in rural Bangladesh, this paper finds strong evidence that corruption in schools is doubly regressive: (i) the poor are more likely to pay bribes, and (ii) among the bribe payers, the poor pay a higher share of their income.
Working Paper 6671
|Is Workfare Cost-Effective against Poverty in a Poor Labor-Surplus Economy?|
October 2013 - Workfare schemes impose work requirements on beneficiaries. This has seemed an attractive idea for self-targeting transfers to poor people. This incentive argument does not imply, however, that workfare is more cost-effective against poverty than even poorly-targeted options, given hidden costs of participation. In particular, even poor workfare participants in a labor-surplus economy can be expected to have some forgone income when they take up such a scheme. A survey-based method is used to assess the cost-effectiveness of India's Employment Guarantee Scheme in Bihar. Participants are found to have forgone earnings, although these fall well short of market wages on average. Factoring in these hidden costs, the paper finds that for the same budget, workfare has less impact on poverty than either a basic-income scheme (providing the same transfer to all) or uniform transfers based on the government's below-poverty-line ration cards.
Working Paper 6673
|Testing Information Constraints on India’s Largest Antipoverty Program|
September 2013 - Public knowledge about India's ambitious Employment Guarantee Scheme is low in one of India's poorest states, Bihar, where participation is also unusually low. Is the solution simply to tell people their rights? Or does their lack of knowledge reflect deeper problems of poor people's agency and an unresponsive supply side? This paper reports on an information campaign that was designed and implemented in the form of an entertaining movie to inform people of their rights under the scheme. In randomly-assigned villages, the movie brought significant gains in knowledge and more positive perceptions about the impact of the scheme. But objectively measured employment showed no gain on average, suggesting that awareness generation needs to go hand-in-hand with supply-side changes.
Working Paper 6598
|China's 2008 labor contract law: implementation and implications for China's workers|
July 2013 - This paper presents empirical evidence from household and firm survey data collected during 2009-2010 on the implementation of the 2008 Labor Contract Law and its effects on China's workers. The government and local labor bureaus have made substantial efforts to enforce the provisions of the new law, which has likely contributed to reversing a trend toward increasing informalization of the urban labor market. Enforcement of the law, however, varies substantially across cities. Education is positively correlated with satisfaction with the enforcement of the law, the likelihood of having a labor contract, awareness of the content of the law, and the likelihood of initiating a dispute.
Working Paper 6542
|Incentivizing schooling for learning: evidence on the impact of alternative targeting approaches|
July 2013 - This paper evaluates a primary school scholarship program in Cambodia with two different targeting mechanisms, one based on poverty level and the other on baseline test scores ("merit"). Both targeting mechanisms increased enrollment and attendance. However, only the merit-based targeting induced positive effects on test scores. The paper shows that the asymmetry of response is unlikely to have been driven by differences between recipients' characteristics.
Working Paper 6541
|Impact evaluation of three types of early childhood development interventions in Cambodia|
July 2013 - Scaling up early childhood development services has the potential to increase children's cognitive and socio-emotional development and promote school readiness in a large segment of the population. This study used a randomized controlled trial approach to evaluate three scaled-up programs designed to widen access to early childhood development services: formal preschools, community preschools, and home-based services. The impacts of all three programs fell short of expectations because of two key flaws in how they were scaled up – weak implementation, and insufficient promotion.
Working Paper 6540
|Long-term impacts of household electrification in rural India|
June 2013 - India's huge expansion in rural electrification in the 1980s and 1990s offers lessons for other countries today. The paper examines the long-term effects of household electrification on consumption, labor supply, and schooling in rural India over 1982-99. It finds that household electrification brought significant gains to consumption and earnings, the latter through changes in market labor supply. It finds positive effects on schooling for girls but not for boys.
Working Paper 6527
|It's only words: validating the CPIA governance assessments|
June 2013 - This study analyzes the validity of the World Bank's Country Policy and Institutional Assessments governance ratings, an important factor in allocating the Bank's concessionary International Development Association funds. It tests for certain biases in the ratings, and examines the quality of the written justifications that accompany the ratings. The study finds no evidence of bias in favor of International Development Association-eligible countries, despite a potential moral hazard problem inherent in the ratings process.
Working Paper 6526
|A public strategy for compliance monitoring|
June 2013 - Theoretical accounts of compliance with court orders emphasize the importance of transparency. Most empirical studies of compliance center on high profile political cases, largely ignoring the high-volume, quotidian claims against the state for basic services that constitute the largest share of court dockets in many jurisdictions. This paper uses a unique dataset on compliance with orders from the Constitutional Chamber of the Supreme Court of Costa Rica to examine the determinants of compliance in low salience cases.
Working Paper 6523
|Expanding Social Insurance Coverage in Urban China|
June 2013 - This paper first reviews the history of social insurance policy and coverage in urban China, documenting the evolution in the coverage of pensions and medical and unemployment insurance for both local residents and migrants, and highlighting obstacles to expanding coverage. The paper then uses two waves of the China Urban Labor Survey, conducted in 2005 and 2010, to examine the correlates of social insurance participation before and after implementation of the 2008 Labor Contract Law.
Working Paper 6497
|Conducting Ethical Economic Research: Complications from the Field|
May 2013 - This essay discusses practical issues confronted when conducting surveys as well as designing appropriate field trials. First, it looks at the challenge of ensuring transparency while maintaining confidentiality. Second, it explores the role of trust in light of asymmetric information held by the surveyor and by the respondents as well as the latter's expectations as to what their participation will set in motion. The authors present case studies relevant to both of these issues. Finally, they discuss the role of ethical review from the perspective of research conducted through the World Bank.
Working Paper 6446
|Building or Bypassing Recipient Country Systems: Are Donors Defying the Paris Declaration?|
April 2013 - The 2005 Paris Declaration committed donors to increased use by donors of recipient country systems for managing aid, particularly in recipient countries with higher-quality systems. This study investigates the degree to which donors’ use of country systems is in fact positively related to their quality, using indicators explicitly endorsed for this purpose by the Paris Declaration and covering the 2005-2010 period. Tests confirm a positive and significant relationship that is robust to corrections for potential sample selection, omitted variables, and endogeneity bias. Findings suggest that donors have modified at least some of their aid practices in ways that build rather than undermine administrative capacity and accountability mechanisms in recipient countries.
Working Paper 6423
|Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda|
February 2013 - Paying for performance (P4P) provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling, using data from a prospective quasi-experimental design. The study finds a positive impact of P4P with an increase of 6.1 percentage points in the probability of individuals having ever been tested. Larger impacts are found for married individuals. The P4P impact is also larger for the probability that both partners have ever been tested, especially among discordant couples in which only one of the partners is HIV positive.
Working Paper 6364
|How Subjective Beliefs about HIV Infection Affect Life-Cycle Fertility: Evidence from Rural Malawi|
January 2013 - This paper uses simulation methods with a structural model to study the effect of subjective beliefs about HIV infection on fertility decisions in a context of high HIV prevalence and simulates the impact of different policy interventions, such as HIV testing programs and prevention of mother-to-child transmission, on fertility and child mortality. The model successfully fits the fertility patterns in the data, as well as the distribution of reported beliefs about own HIV status. The simulation results show that the presence of HIV reduces the average number of births a woman has during her life-cycle by 0.15, and that HIV testing can reduce the fertility of infected women, leading to a reduction of child mortality and orphanhood.
Working Paper 6343
|Cash Transfers and Child Schooling: Evidence from a Randomized Evaluation of the Role of Conditionality|
January 2013 - A randomized experiment was conducted in rural Burkina Faso to estimate the impact of alternative cash transfer delivery mechanisms on education. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional. Families under the conditional schemes were required to have their children ages 7-15 enrolled in school and attending classes regularly. There were no such requirements under the unconditional programs. Conditional transfers were found to be significantly more effective than the unconditional transfers in improving the enrollment of "marginal children" who are initially less likely to go to school, such as girls, younger children, and lower-ability children.
Working Paper 6340
|Buying votes vs. supplying public services: political incentives to under-invest in pro-poor policies|
January 2013 - Using unique survey data, this paper finds evidence that vote-buying in poor economies is associated with lower provision of public services that disproportionately benefit the poor and worse child health. Various features of the data and the institutional context allow the rejection of alternative hypotheses, such as poverty driving both vote buying and health outcomes. The data come from the Philippines, a country context that allows for measuring vote-buying during elections and services delivered by the administrative unit controlled by winners of those elections.
Working Paper 6339
|MDGs That Nudge: The Millennium Development Goals, Popular Mobilization, and the Post-2015 Development Framework|
November 2012 - The Millennium Development Goals, which expire in 2015, were a global agreement to promote human development and reduce poverty. But they did not create a legalized institutional regime, in which precise obligations would be delegated to specific actors, nor were they, in many respects, compatible with the incentives of the countries whose heads of state endorsed them. They most resembled international human rights treaties, which are also not legally coercive, and which achieve their effects largely through their role in social and political mobilization. But unlike human rights treaties, the Millennium Development Goals' targets and goals were not psychologically, morally, and politically salient.
Working Paper 6282
|Perils of simulation: parallel streams and the case of stata's rnormal command|
November 2012 - Large-scale simulation-based studies rely on at least three properties of pseudorandom number sequences: they behave in many ways like truly random numbers; they can be replicated; and they can be generated in parallel. There has been some divergence, however, between empirical techniques employing random numbers, and the standard battery of tests used to validate them. A random number generator that passes tests for any single stream of random numbers may fail the same tests when it is used to generate multiple streams in parallel. The lack of systematic testing of parallel streams leaves statistical software with important potential vulnerabilities. This paper shows one such vulnerability in Stata's rnormal function that went unnoticed for almost four years, and how to detect it. It then shows practical implications for the use of parallel streams in existing software.
Working Papaer 6278
|Evaluating Workfare When the Work Is Unpleasant:Evidence for India’s National Rural Employment Guarantee Scheme|
November 2012 - Prevailing practices in evaluating workfare programs have ignored the disutility of the type of work done, with theoretically ambiguous implications for the impacts on poverty. In the case of India's National Rural Employment Guarantee Scheme, past assessments have relied solely on household consumption per person as the measure of economic welfare.
Working Paper 6272
|Handwashing Behavior Change at Scale: Evidence from a Randomized Evaluation in Vietnam|
September 2012 - Handwashing with soap campaigns are de rigueur in developing countries, but little is known about their effectiveness. This paper evaluates a large-scale handwashing campaign in three provinces of Vietnam in 2010. Exposure to the campaign resulted in a slight increase in the availability of handwashing materials in the household, and caregivers in the treatment group were more likely to report washing hands at some of the times emphasized by the campaign. However, no differences were found between the treatment and control groups in actual handwashing with soap, the average level of which remains very low.
Working Paper 6207
|Women’s Access to Labor Market Opportunities, Control of Household Resources, and Domestic Violence|
July 2012 - While there are many positive societal implications of increased female labor force opportunities, some theoretical models and empirical evidence suggest that working can increase a woman's risk of suffering domestic violence. Using a dataset collected in peri-urban Dhaka, this analysis documents a positive correlation between work and domestic violence. This correlation is only present among women with less education or who were younger at first marriage. These results are consistent with a theoretical model in which a woman with low bargaining power can face increased risk of domestic violence upon entering the labor force as a husband seeks to counteract her increased bargaining power, while a woman with higher baseline bargaining power is protected from domestic violence because she can leave a violent marriage.
Working Paper 6149
|The Impacts of Public Hospital Autonomization: Evidence from a Quasi-Natural Experiment|
July 2012 - This paper exploits the staggered rollout of Vietnam’s hospital autonomization policy to estimate its impacts on several key health sector outcomes including hospital efficiency, use of hospital care, and out-of-pocket spending. The authors use six years of panel data covering all Vietnam’s public hospitals, and three stacked cross-sections of household data. Autonomization probably led to more hospital admissions and outpatient department visits, although the effects are not large. It did not, however, affect bed stocks or bed-occupancy rates. Nor did it increase hospital efficiency. Oddly, despite the volume effects and the unchanged cost structure, the analysis does not find any evidence of autonomization leading to higher total costs. It does, however, find some evidence that autonomization led to higher out-of-pocket spending on hospital care, higher spending per treatment episode, and more lab tests and imaging per case.
Working Paper 6137
|The health effects of universal health care: evidence from Thailand|
July 2012 - This paper exploits the staggered rollout of Thailand’s universal health coverage scheme to estimate its impacts on whether individuals report themselves as being too ill to work. The analysis finds that universal coverage reduced the likelihood of people reporting themselves to be too sick to work: the authors estimate the effect to be -0.004 one year after universal coverage and -0.007 three years after. The estimated effects are much larger among those age 65 and over. Universal coverage had a much larger effect on health (about four times larger) than the Village Fund scheme, which provided free credit to rural households through a subsidized microcredit scheme and which was rolled out around the same time as universal coverage.
Working Paper 6119
|Universal health care and informal labor markets: the case of Thailand|
July 2012 - This paper explores the possibility that universal health coverage may inadvertently result in distorted labor market choices, with workers preferring informal employment over formal employment, leading to negative effects on investment and growth, as well as reduced protection against non-health risks and the income risks associated with ill health. It explores this hypothesis in the context of the Thai universal coverage scheme, which was rolled out in four waves over a 12-month period starting in April 2001. It identifies the effects of universal coverage through the staggered rollout, and gains statistical power by using no less than 68 consecutive labor force surveys, each containing an average of 62,000 respondents. The analysis finds that universal coverage appears to have encouraged employment especially among married women, to have reduced formal-sector employment among married men but not among other groups, and to have increased informal-sector employment especially among married women. The largest positive informal-sector employment effects are found in the agricultural sector.
Working Paper 6116
|Does Africa Need a Rotten Kin Theorem? Experimental Evidence from Village Economies|
June 2012 - This paper measures the economic impact of social pressure to share income with kin and neighbors in rural Kenyan villages. The authors conduct a lab experiment in which they randomly vary the observability of investment returns. The goal is to test whether subjects reduce their income in order to keep it hidden. The authors find that women adopt an investment strategy that conceals the size of their initial endowment in the experiment, although that strategy reduces their expected earnings. This effect is largest among women with relatives attending the experiment. Parameter estimates suggest that women behave as though they expect to be pressured to share four percent of their observable income with others, and substantially more when close kin can observe income directly.
Working Paper 6085
|Does It Pay to Be a Cadre? Estimating the Returns to Being a Local Official in Rural China|
June 2012 - Recruiting and retaining leaders and public servants at the grass-roots level in developing countries creates a potential tension between providing sufficient returns to attract talent and limiting the scope for excessive rent-seeking behavior. In China, researchers have frequently argued that village cadres, who are the lowest level of administrators in rural areas, exploit personal political status for economic gain. Much of the existing research, however, simply compares the earnings of cadre and non-cadre households in rural China without controlling for unobserved dimensions of ability that are also correlated with success as entrepreneurs or in non-agricultural activities. This paper avoids this pitfall. It finds measurable – but not large – return to cadre status, but that they have been increasing over time. The latter is hardly surprising given that part of the return arises through returns earned in off-farm employment from businesses and economic activities managed by villages, and that returns to non-agricultural employment have been rising since China's economic reforms began.
Working Paper 6082
|Patterns and correlates of intergenerational non-time transfers: evidence from CHARLS |
June 2012 - Using the China Health and Retirement Longitudinal Study 2008 pilot, this paper analyzes the patterns and correlates of intergenerational transfers between elderly parents and adult children in Zhejiang and Gansu Provinces. The pilot is a unique data source from China that provides information on the direction as well as amount of transfers between parents and each of their children, and clearly distinguishes transfers between parents and children from those among other relatives or friends. The paper shows that transfers flow predominantly from children to elderly parents, with transfers from children playing an important role in elderly support. Educated and married children have a higher tendency to provide transfers to their parents; and oldest sons are less likely to provide transfers than their younger brothers. In the absence of some other source of elderly support (such as a public pension or own savings), the dwindling number of children implies that the financial burden associated with supporting the elderly is likely to increase.
Working Paper 6076
|When Do Donors Trust Recipient Country Systems?|
April 2012 - The 2005 Paris Declaration on Aid Effectiveness sets targets for increased use by donors of recipient country systems for managing aid. The target is premised on a view that country systems are strengthened when donors trust recipients to manage aid funds, but undermined when donors do not. This study provides an analytical framework for understanding donors' decisions to trust or bypass country systems, and conducts empirical tests using data from three OECD-DAC surveys. Results show that a donor's use of the recipient country's systems is positively related to the donor's share of aid provided to the recipient, perceptions of corruption in the recipient country, and public support for aid in the donor country. Findings are robust to corrections for potential sample selection, omitted variables or endogeneity bias.
Working Paper 6019
|Does India’s Employment Guarantee Scheme Guarantee Employment?|
March 2012 - In 2005 India introduced an ambitious national anti-poverty program, now called the Mahatma Gandhi National Rural Employment Guarantee Scheme. The program aims to dramatically reduce poverty by offering up to 100 days of unskilled manual labor per year on public works projects for any rural resident paid at the stipulated minimum wage rate. Analysis of data from India's National Sample Survey for 2009/10 reveals considerable unmet demand for work in all states. Poorer families tend to have more demand for work on the scheme, and (despite the unmet demand) the self-targeting mechanism allows it to reach relatively poor families and backward castes. The extent of the unmet demand is greater in the poorest states – ironically where the scheme is needed most.
Working Paper 6003
|The Law’s Majestic Equality? The Distributive Impact of Litigating Social and Economic Rights|
March 2012 - Optimism about the use of laws, constitutions, and rights to achieve social change has never been higher among practitioners. But the academic literature is skeptical that courts can direct resources toward the poor. Using data on social and economic rights cases in five countries, the authors examine whether the poor are over or under-represented among the beneficiaries of litigation, relative to their share of the population. They find that the impact of courts varies considerably across the cases, but is positive and pro-poor in two of the five countries (India and South Africa), distribution-neutral in two others (Indonesia and Brazil), and sharply anti-poor in Nigeria. Overall, the results of litigation are much more positive for the poor than conventional wisdom would suggest.
Working Paper 5999
|Sexual Behavior Change Intentions and Actions in the Context of a Randomized Trial of a Conditional Cash Transfer for HIV Prevention in Tanzania|
March 2012 - Information, education, communication and interventions based on behavioral-change communication have had success in increasing the awareness of HIV. But these strategies alone have been less successful in changing risky sexual behavior. This paper addresses this issue by exploring the link between action and the intention to change behaviors. Based on an incentives-based HIV prevention trial in Tanzania, the longitudinal dataset in this paper allows the exploration of intended strategies for changing sexual behaviors and their results. The authors find that gender, intervention groups and new positive diagnoses of sexually transmitted infections can significantly predict the link between intent and action. The paper examines potential mediators of these relationships.
Working Paper 5997
|Weathering a Storm: Survey-Based Perspectives on Employment in China in the Aftermath of the Global Financial Crisis|
March 2012 - Evidence from a range of different sources suggests that Chinese workers lost 20-36 million jobs because of the global financial crisis. Most of these layoffs affected migrant workers, who have typically lacked employment protection, tend to be concentrated in export-oriented sectors, and were among the easiest to dismiss when the crisis hit. Although it was severe, the employment shock was short-lived. By mid-2009, the macroeconomic stimulus and other interventions had succeeded in boosting demand for migrant labor. By early 2010, abundant evidence pointed to scarcity in China's labor market, as labor demand was once again leading to brisk growth in wages.
Working Paper 5984
|Stimulating demand for AIDS prevention: lessons from the RESPECT trial|
February 2012 - HIV-prevention strategies have yielded only limited success so far in slowing down the AIDS epidemic. This paper examines novel intervention strategies that use incentives to discourage risky sexual behaviors. Widely-adopted conditional cash transfer programs that offer payments conditioning on easily monitored behaviors, such as well-child health care visits, have shown positive impact on health outcomes. Similarly, contingency management approaches have successfully used outcome-based rewards to encourage behaviors that are not easily monitored, such as stopping drug abuse. These strategies have not been used in the sexual domain, so this paper assesses how incentives can be used to reduce risky sexual behavior. After discussing theoretical pathways, it discusses the use of sexual-behavior incentives in the Tanzanian RESPECT trial. There, participants who tested negative for sexually transmitted infections are eligible for outcome-based cash rewards.
Working Paper 5973
|Mines, Migration and HIV/AIDS in Southern Africa|
February 2012 - Swaziland and Lesotho have the highest HIV prevalence in the world. They also share another distinct feature: during the last century, they sent a large numbers of migrant workers to South African mines. A job in the mines means leaving for long periods away from their families and living in an area with an active sex industry. This creates potential incentives for multiple, concurrent partnerships. Using Demographic and Health Surveys, this paper shows that migrant miners ages 30-44 are 15 percentage points more likely to be HIV positive, and women whose partner is a migrant miner are 8 percentage points more likely to become infected. Miners are less likely to abstain or to use condoms, and female partners of miners are more likely to engage in extramarital sex.
Working Paper 5966
|Child Labor, Schooling, and Child Ability|
February 2012 - Using data collected in rural Burkina Faso, this paper examines how children's cognitive abilities influence households' decisions to invest in their education. Taking into account the endogeneity of child ability measures, the analysis finds that negative shocks in utero lead to 0.24 standard deviations lower ability z-scores, corresponding to a 38 percent enrollment drop and a 49 percent increase in child labor hours compared with their siblings. Negative education impacts are largest for in-utero shocks, smaller for shocks before age two, and negligible after age two.
Working Paper 5965
|Alternative Cash Transfer Delivery Mechanisms: Impacts on Routine Preventative Health Clinic Visits in Burkina Faso|
January 2012 - The authors conducted a unique randomized experiment to estimate the impact of two alternative cash transfer delivery mechanisms on household demand for routine preventative health services in rural Burkina Faso. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional, and the money was given to either mothers or fathers. Families enrolled in the conditional cash transfer schemes were required to obtain quarterly child-growth monitoring at local health clinics for all children under five years old. There was not such a requirement under the unconditional programs. Compared with control group households, conditional cash transfers significantly increased the number of preventative health care visits during the previous year, while unconditional cash transfers did not have such an impact. For the conditional cash transfers, money given to mothers or fathers showed beneficial impacts of similar magnitude in increasing routine visits.
Working Paper 5958
|Do Informed Citizens Receive More…or Pay More? The Impact of Radio on the Government Distribution of Public Health Benefits|
January 2012 - The government provision of free or subsidized bed nets to combat malaria in Benin allows the identification of new channels through which mass media affect public policy outcomes. Prior research has concluded that governments provide greater private benefits to better-informed individuals. This paper shows, for the first time, that governments can also respond by exploiting informed individuals' greater willingness to pay for these benefits. Using a "natural experiment" in radio markets in northern Benin, the paper finds that media access increases the likelihood that households pay for the bed nets they receive from government, rather than getting them for free. Mass media appears to change the private behavior of citizens – in this case, to invest more of their own resources on a public health good (bed nets) – but not their ability to extract greater benefits from government.
Working Paper 5952
|Human rights as demands for communicative action|
January 2012 - A key issue with human rights is how to allocate duties correlative to rights claims. This paper addresses the issue by taking the practices of domestic courts in several countries as a normative benchmark. Upon reviewing how courts in Colombia, India, South Africa, Indonesia, and elsewhere have allocated duties associated with socio-economic rights, the paper finds that courts urge parties to move from an adversarial to an investigative mode, impose requirements that parties argue in good faith, and structure a public forum of communication. The conclusion argues that judicial practice involves requiring respondents to engage in communicative, instead of strategic, action, and explores the implications of this understanding of human rights.
Working Paper 5951
|Human rights based approaches to development: concepts, evidence, and policy|
January 2012 - This paper assesses the benefits, risks, and limitations of human rights-based approaches to development, which can be catalogued on the basis of the institutional mechanisms they rely on: global compliance based on international and regional treaties; the policies and programming of donors and executive agencies; rights talk; and legal mobilization. The paper briefly reviews the politics of the first three kinds of human rights based approaches before examining constitutionally-based legal mobilization for social and economic rights in greater detail. Litigation for social and economic rights is increasing in frequency and scope in several countries, and exhibits appealing attributes, such as inclusiveness and deliberative quality. Still, there are potential problems with this form of human rights based mobilization, including middle class capture, the potential counter-majoritarianism of courts, and difficulties in compliance. The conclusion summarizes what is known, and what remains to be studied, regarding human rights based approaches to development.
Working Paper 5938
|Aid tying and donor fragmentation|
January 2012 - This study tests two opposing hypotheses about the impact of aid fragmentation on the practice of aid tying. In one, when a small number of donors dominate the aid market in a country, they may exploit their monopoly power by tying more aid to purchases from contractors based in their own countries. Alternatively, when donors have a larger share of the aid market, they may have stronger incentives to maximize the development impact of their aid by tying less of it. Empirical tests strongly and consistently support the latter hypothesis: higher donor aid shares are associated with less, not more, aid tying.
Working Paper 5934
|Average and Marginal Returns to Upper Secondary Schooling in Indonesia|
November 2011 - This paper estimates average and marginal returns to schooling in Indonesia using a non-parametric selection model estimated by local instrumental variables, and data from the Indonesia Family Life Survey. The analysis finds that the return to upper secondary schooling varies widely across individual: it can be as high as 50 percent per year of schooling for those very likely to enroll in upper secondary schooling, or as low as -10 percent for those very unlikely to do so. Returns to the marginal student (14 percent) are well below those for the average student attending upper secondary schooling (27 percent).
Working Paper 5878
|The Measurement of Educational Inequality: Achievement and Opportunity|
November 2011 - This paper proposes two related measures of educational inequality: one for educational achievement and another for educational opportunity. The former is the variance in test scores. Its selection is informed by consideration of two measurement issues that have typically been overlooked in the literature: the implications of the standardization of test scores for inequality indices, and the possible sample selection biases arising from the Program of International Student Assessment (PISA) sampling frame. Inequality of educational opportunity is measured by the share of the variance in test scores that is explained by pre-determined circumstances. Both measures are computed for the 57 countries in which PISA surveys were conducted in 2006. Inequality of opportunity accounts for up to 35 percent of all disparities in educational achievement, and is larger in (most of) continental Europe and Latin America than in Asia, Scandinavia, and North America.
Working Paper 5873
|The Labor Supply and Retirement Behavior of China’s Older Workers and Elderly in Comparative Perspective|
October 2011 - As is common in many developing countries, China can be characterized as having two retirement systems: a formal system, under which urban employees receive generous pensions and face mandatory retirement by age 60, and an informal system, under which rural residents and individuals in the informal sector rely on family support in old age and have much longer working lives. Gender differences in age of exit from work are shown to be much greater in urban China than in rural areas, and are greater than observed in Korea and Indonesia. Pension-eligible workers are far more likely to cease productive activity at a relatively young age. A strong relationship between health status and labor supply in rural areas is also observed.
Working Paper 5853
|Four Decades of Health Economics through a Bibliometric Lens|
October 2011 - Adam Wagstaff and Anthony J Culyer take a bibliometric tour of the past 40 years of health economics using bibliographic "metadata" from EconLit supplemented by citation data from Google Scholar and the authors' topical classifications. They report the growth of health economics (33,000 publications since 1969), list the 300 most-cited publications broken down by topic, and the changing topical and geographic focus of health economics. They also compare authors, countries, institutions, and journals in terms of the volume of publications and their influence as measured through various citation-based indices.
Working Paper 5829
|Does Expanding Health Insurance beyond Formal-Sector Workers Encourage Informality? Measuring the Impact of Mexico’s Seguro Popular|
August 2011 - Seguro Popular was introduced in 2002 to provide health insurance to the 50 million Mexicans without Social Security. This paper tests whether the program has had unintended consequences, distorting workers' incentives to operate in the informal sector. The paper finds that Seguro Popular lowers formality by 0.4-0.7 percentage points, with adjustments largely occurring within a few years of the program's introduction. Rather than encouraging exit from the formal sector, Seguro Popular is associated with a 3.1 percentage point reduction (a 20 percent decline) in the inflow of workers into formality. The impact is larger for those with less education, in larger households, and with someone else in the household guaranteeing Social Security coverage.
Working Paper 5785
|The Impact of Recall Periods on Reported Morbidity and Health Seeking Behavior|
August 2011 - Between 2000 and 2002, the authors followed 1621 individuals in Delhi, India, using a combination of weekly and monthly-recall health questionnaires. In 2008, they augmented these data with another 8 weeks of surveys during which households were experimentally allocated to surveys with different recall periods in the second half of the survey. This paper shows that the length of the recall period had a large impact on reported morbidity, doctor visits, time spent sick, whether at least one day of work/school was lost due to sickness, and the reported use of self-medication. The effects are more pronounced among the poor than the rich. In one example, differential recall effects across income groups reverse the sign of the gradient between doctor visits and per-capita expenditures.
Working Paper 5778
|A Hybrid Approach to Efficiency Measurement with Empirical Illustrations from Education and Health|
August 2011 - Inefficiency is commonplace, yet exercises aimed at improving provider performance efforts to date to measure inefficiency and use it in benchmarking exercises have not been altogether satisfactory. This paper proposes a new approach that blends the themes of Data Envelopment Analysis and the Stochastic Frontier Approach to measure overall efficiency. The hybrid approach nonparametrically estimates inefficiency by comparing actual performance with comparable real-life "best practice" on the frontier and could be useful in exercises aimed at improving provider performance. Four applications in the education and health sectors are used to illustrate the features and strengths of this hybrid approach.
Working Paper 5751
|Crossing boundaries: gender, caste and schooling in rural Pakistan|
June 2011 - This paper analyzes social barriers to education attainment in rural Pakistan. It finds that low-caste children are deterred from enrolling when the school is dominated by high-caste households. In particular, low-caste girls, the most educationally disadvantaged group, benefit from improved school access only when the school is also caste-concordant.
Working Paper 5710
|Lasting Welfare Effects of Widowhood in a Poor Country|
July 2011 - Malian households headed by widows have significantly lower living standards on average than male- or other female-headed households; this holds even after controlling for household and individual characteristics such as age. Furthermore, the adverse welfare effects of widowhood appear to persist even after widows are absorbed into male headed households. Relative to other women, worse outcomes for ever-widowed women persist through remarriage. These detrimental effects are passed on to children, indicating an intergenerational transmission of poverty stemming from widowhood.
Working Paper 5734
|Civil Society, Public Action and Accountability in Africa|
July 2011 - This paper examines the potential role of civil society action in increasing state accountability for development in Sub-Saharan Africa. It further develops the analytical framework of the World Development Report 2004 on accountability relationships, to emphasize the underlying political economy drivers of accountability and implications for how civil society is constituted and functions. It argues on this basis that the most important domain for improving accountability is through the political relations between citizens, civil society, and state leadership.
Working Paper 5733
|The correlation between human capital and morality and its effect on economic performance: theory and evidence |
June 2011 - This paper incorporates morality into a simple static general equilibrium model in which agents choose whether to be producers or appropriators. The authors analyze the relationship between the correlation between morality and human capital on the one hand, and aggregate economic performance on the other. They show that there is a main effect that tends to cause this relationship to be positive, and secondary effects that may reinforce or oppose the main effect. Empirical tests find evidence that higher within-country correlation between morality and ability increases per-capita income levels. Results are robust to correcting for endogeneity and to changes in sample and specification.
Working Paper 5720
|Population, poverty, and sustainable development: a review of the evidence |
June 2011 - There is a very large but scattered literature debating the economic implications of high fertility. This paper reviews the literature on three themes: (a) Does high fertility affect low-income countries' prospects for economic growth and poverty reduction? (b) Does population growth exacerbate pressure on natural resources? and (c) Are family planning programs effective at lowering fertility, and should they be publicly funded? The literature shows broad consensus that while policy and institutional settings are key in shaping the prospects of economic growth and poverty reduction, the rate of population growth also matters. Recent studies find that low dependency ratios (as fertility declines) create an opportunity for increasing productivity, savings and investment in future growth. They find that lower fertility is associated with better child health and schooling, and better health and greater labor-force participation for women.
Working Paper 5719
|Trends and socioeconomic gradients in adult mortality around the developing world |
June 2011 - Sibling histories from respondents to 84 DHS surveys from 46 countries yield four main findings. First, while under-5 mortality has fallen over time, adult mortality has not. Second, the increase in Sub-Saharan African was dramatic among those most affected by HIV/AIDS: mortality rates in the highest HIV-prevalence countries exceed those in countries that experienced civil war. Third, mortality rates are stagnating—in some cases increasing—even where HIV-prevalence is lower. Finally, adult mortality rates in Sub-Saharan Africa have risen substantially faster for men than for women. The data do not show large gaps by urban/rural residence or by school attainment.
Working Paper 5716
|Intersubjective meaning and collective action in 'fragile' societies: theory, evidence and policy implications|
June 2011 - The capacity to act collectively is not just a matter of groups sharing interests, incentives and values (or being sufficiently small), as standard economic theory predicts, but a prior and shared understanding of the constituent elements of problem(s) and possible solutions. From this standpoint, the failure to act collectively can stem at least in part from relevant groups failing to ascribe a common intersubjective meaning to situations, processes and events. Though this is a general phenomenon, it is particularly salient in countries characterized by societal fragility and endemic conflict. We develop a conceptual account of intersubjective meanings, explain its relevance to development practice and research, and examine its implications for development work related to building the rule of law and managing common pool resources.
Working Paper 5707
|Redressing grievances and complaints regarding basic service delivery|
June 2011 - Redress procedures are important for basic fairness. In addition, they can help address principal-agent problems in the implementation of social policies and provide information to policy makers regarding policy design. To function effectively, a system of redress requires a well-designed and inter-linked supply of redress procedures as well as, especially if rights consciousness is not well-developed in a society, a set of organizations that stimulate and aggregate demand for redress. On the supply side, this paper identifies three kinds of redress procedures: administrative venues within government agencies, independent institutions outside government departments, and courts. On the demand side, the key institutions are nongovernmental organizations/civil society organizations and the news media, both of which require a receptive political and economic climate to function effectively. Overall, procedures for redressing grievances and complaints regarding basic service delivery are under-developed in many countries, and deserve further analysis, piloting, and support.
Working Paper 5699
|Students Today, Teachers Tomorrow? Identifying Constraints on the Provision of Education|
June 2011 - With an estimated 115 million children not attending primary school in the developing world, increasing access to education is critical. Resource constraints limit the effectiveness of demand-based subsidies, raising the question of how effective supply-side channels might be. This paper finds that the presence of a government girls' secondary school substantially increases the local supply of skilled women, lowers teacher wages locally, and increases by a factor of three the likelihood that an affordable private school will emerge. These findings highlight the prominent role of women as teachers in facilitating educational access.
Working Paper 5674
|Is it what you inherited or what you learnt? Intergenerational linkage and interpersonal inequality in Senegal|
May 2011 - Institutional features of the African setting -- large extended families and imperfect credit and land markets -- matter to the equity and efficiency roles played by intergenerational linkages. Using original survey data on Senegal that include an individualized measure of consumption, this paper finds among other things that inheritance of non-land assets and the education and occupation of parents (especially the mother) and their choices about children's schooling are more important to adult welfare than property inheritance. Significant gender inequality in consumption is evident, although it is almost entirely explicable in terms of factors such as education and (non-land) inheritance.
Working Paper 5658
|Income Shocks and Adolescent Mental Health|
April 2011 - The provision of monthly cash transfers in Malawi had a strong beneficial impact on the mental health of school-age girls during the two-year intervention. Among baseline schoolgirls who were offered unconditional cash transfers, the likelihood of suffering from psychological distress was 38 percent lower than the control group, while the same figure was 17 percent if the cash transfers offers were made conditional on regular school attendance. No impact is found on the mental health of girls who had already dropped out of school at baseline. The beneficial effects of cash transfers were limited to the intervention period and dissipated quickly after the program ended.
Working Paper 5644
|School Inputs, Household Substitution, and Test Scores|
April 2011 - Empirical studies of the relationship between school inputs and test scores typically do not account for the fact that households will respond to changes in school inputs. This paper presents a dynamic household optimization model relating test scores to school and household inputs, and tests its predictions in two very different low-income country settings -- Zambia and India. The authors measure household spending changes and student test score gains in response to unanticipated as well as anticipated changes in school funding. Consistent with the optimization model, they find in both settings that households offset anticipated grants more than unanticipated grants. They also find that unanticipated school grants lead to significant improvements in student test scores but anticipated grants have no impact on test scores.
Working Paper 5629
|A Practical Comparison of the Bivariate Probit and Linear IV Estimators|
March 2011 - This paper presents asymptotic theory and Monte-Carlo simulations comparing maximum-likelihood bivariate probit and linear instrumental variables estimators of treatment effects in models with a binary endogenous treatment and binary outcome. The three main contributions of the paper are (1) clarifying the relationship between the Average Treatment Effect obtained in the bivariate probit model and the Local Average Treatment Effect estimated through linear IV; (2) comparing the mean-square error and the actual size and power of tests based on these estimators across a wide range of parameter values relative to the existing literature; and (3) assessing the performance of misspecification tests for bivariate probit models. The authors recommend two changes to common practices: bootstrapped confidence intervals for both estimators, and a score test to check goodness of fit for the bivariate probit model.
Working Paper 5601
|Mass Media and Public Services: The Effects of Radio Access on Public Education in Benin|
February 2011 - Does radio access improve public service provision? And if so, does it do so by increasing government accountability to citizens, or by persuading households to take advantage of publicly provided services? Using unique data from Benin, this paper finds that literacy rates among school children are higher in villages exposed to signals from a larger number of community radio stations. But in contrast to prior research, the authors find that this media effect does not operate through government accountability: government inputs into village schools and household knowledge of government education policies are no different in villages with greater access to community radio. Instead, households with greater access are more likely to make financial investments in the education of their children.
Working Paper 5559
|Crossing the threshold: an analysis of IBRD graduation policy|
January 2011 - According to World Bank policy, countries remain eligible to borrow from the IBRD until they are able to sustain long-term development without further recourse to Bank financing. Graduation is not an automatic consequence of reaching a particular income level, but rather is supposed to be based on a determination of whether the country has reached a level of institutional development and capital-market access that enables it to sustain its own development process without recourse to IBRD funding. This paper finds that a number of variables have influenced graduation decisions in a manner that is generally consistent with the stated policy. Countries that are wealthier, more creditworthy, more institutionally developed, and less vulnerable to shocks are more likely to have graduated. Predicted probabilities generated by the model correspond closely to the actual graduation and de-graduation experiences of most countries (such as Korea and Trinidad and Tobago), and suggest that Hungary and Latvia may have graduated prematurely—a prediction that is consistent with their subsequent return to borrowing from the Bank in the wake of the global financial crisis.
Working Paper 5531
|Shrinking classroom age variance raises student achievement: evidence from developing countries|
January 2011 - This paper investigates whether increased classroom age variance adversely affects mathematics and science achievement. Using exogenous variation in the variance of student age in ability-mixing schools, the author finds robust negative effects of classroom age variance on fourth graders' achievement in developing countries. A simulation demonstrates that re-grouping students by age in the sample can improve math and science test scores by roughly 0.1 standard deviations. According to past estimates for the United States, this effect size is similar to that of raising expenditures per student by 26 percent.
Working Paper 5527
|Food Crisis, Household Welfare and HIV/AIDS Treatment: Evidence from Mozambique|
January 2011 - Using panel data from Mozambique collected in 2007 and 2008, the authors explore the impact of the food crisis on the welfare of households living with HIV/AIDS. The analysis finds that there has been a real deterioration of welfare in terms of income, food consumption, and nutritional status in Mozambique between 2007 and 2008, among both HIV and comparison households. However, HIV households have not suffered more from the crisis than others. Results on the evolution of labor force participation suggest that initiation of treatment and better services in health facilities have counter-balanced the effect of the crisis by improving the health of patients and their labor force participation. The paper finds no effect of the change in welfare on the frequency of visits, but does find that people who experienced a negative income shock also experienced a reduction or a slower progression in treatment outcomes.
Working Paper 5522
|Impact evaluation of school feeding programs in Lao PDR|
January 2011 - Despite the popularity and widespread implementation of school feeding programs, evidence on the impact of school feeding on school participation and nutritional status is mixed. This study evaluates school feeding programs in three northern districts of the Lao PDR. Feeding modalities included on-site feeding, take-home rations, and a combination. District-level implementation of the intervention sites and selective take-up present considerable evaluation challenges. To address these limitations, the authors use difference-in-difference estimators with propensity-score weighting to construct two plausible counterfactuals. They find minimal evidence that the school feeding schemes increased enrollment or improved children’'s nutritional status. Several robustness checks and possible explanations for null findings are presented.
Working Paper 5518
|Can China's rural elderly count on support from adult children? implications of rural-to-urban migration|
December 2010 - This paper shows that support from the family continues to be an important source of support for the rural elderly, particularly the rural elderly over 70 years of age. Decline in likelihood of co-residence with, or in close proximity to, adult children raises the possibility that China's rural elderly will receive less support in the forms of both income and in-kind instrumental care. In fact, on average net financial transfers look set to be similar for elderly households with and without migrant children, but the predicted variance for the latter group is higher suggesting a greater risk of poverty. Reducing this risk is an important motive for China’s new rural pension program scheduled to cover all rural counties by 2016.
Working Paper 5510
|Antiretroviral therapy awareness and risky sexual behaviors: evidence from Mozambique|
November 2010 - This paper studies the effect of increased access to antiretroviral therapy (ART) on risky sexual behavior, using data collected in Mozambique in 2007 and 2008. The survey sampled both households of randomly selected HIV positive individuals and households from the general population. Controlling for unobserved individual characteristics, the findings support the hypothesis of disinhibition behaviors, whereby risky sexual behaviors increase in response to the perceived changes in risk associated with increased access to ART. Furthermore, men and women respond differently to the perceived changes in risk: risky behaviors increase for men who believe, wrongly, that AIDS can be cured, while risky behaviors increase for women who believe, correctly, that ART can treat AIDS but cannot cure it. The findings suggest that scaling up access to ART needs to be accompanied by prevention programs that include educational messages about its effects.
Working Paper 5486
|Did Higher Inequality Impede Growth in Rural China|
November 2010 - This paper estimates the relationship between initial village inequality and subsequent household income growth for a large sample of households in rural China. Using a rich longitudinal survey spanning the years 1987-2002, and controlling for an array of household and village characteristics, the paper finds that households located in higher inequality villages experienced significantly lower income growth through the 1990s. The authors conclude that this relationship is due to unobserved village institutions at the time of economic reforms that were associated with household access to higher income activities. The paper also concludes that local inequality’s predictive power and effects are significantly diminished by the end of the sample.
Working Paper 5483
|Protecting Child Nutritional Status in the Aftermath of a Financial Crisis: Evidence from Indonesia|
November 2010 - This paper evaluates the effectiveness of a supplementary feeding program implemented in the wake of the 1997-1998 economic crises in Indonesia and geared to protecting the nutritional status of infants and young children from adverse effects of the crisis. The analysis exploits heterogeneity in program exposure to eliminate biases due to nonrandom program placement, and to relax the assumption that all targeted children experienced homogenous exposure to the program. The program is estimated to have improved the nutritional status of children aged 12-24 months, and apparently helped avoid problems of severe malnutrition among young children.
Working Paper 5471
|In Aid We Trust: Hearts and Minds and the Pakistan Earthquake of 2005|
October 2010 - Winning "hearts and minds" in the Muslim world is an explicitly acknowledged aim of U.S. foreign policy and increasingly, bilateral foreign aid is recognized as a vehicle towards this end. The authors examine the effect of aid from foreign organizations and on-the-ground presence of foreigners following the 2005 earthquake in Northern Pakistan on local attitudes. They show that four years after the earthquake, humanitarian assistance by foreigners and foreign organizations has left a lasting imprint on population attitudes. The results provide a compelling case that trust in foreigners is malleable, responds to humanitarian actions by foreigners and is not a deep-rooted function of local preferences.
Working Paper 5440
|The impact of the global financial crisis on off-farm employment and earnings in rural China|
October 2010 - This paper examines the effect of the financial crisis on off-farm employment of China's rural labor force. Using a national representative data set collected from across China, the paper finds that there was a substantial impact. By April 2009 off-farm employment reached 6.8 percent of the rural labor force. Monthly earnings also declined. However, while it is estimated that 49 million were laid-off between October 2008 and April 2009, half of them were re-hired in off-farm work by April 2009. By August 2009, less than 2 percent of the rural labor force was unemployed due to the crisis. The robust recovery appears to have helped avoid instability.
Working Paper 5439
|Political economy of infrastructure spending in India|
September 2010 - This paper examines a puzzle in the political economy of infrastructure in India--the coexistence of relatively low shares of capital spending in public budgets alongside evidence of large demand for village infrastructure from poor voters. It argues that this pattern is due to infrastructure projects being used at the margin for political rent-seeking, while spending on employment and welfare transfers are the preferred vehicles to win votes for re-election. New suggestive evidence on the variation of public spending composition across states, and within states over time is offered that is consistent with this argument.
Working Paper 5423
|The value of statistical life: a contingent investigation in China|
September 2010 - This paper presents a study that estimates individuals' willingness to pay for cancer risk prevention in three provinces of China. The results imply that the mean value of willingness to pay for a cancer vaccine that is effective for one year is 759 yuan, with a much lower median value of 171 yuan. The estimated income-elasticity of willingness to pay is 0.42. Using data on the incidence of cancer illness and death in the population, these willingness-to-pay figures imply that the marginal value of reducing the anticipated incidence of cancer mortality by one in the population (i.e. the value of a statistical life) is 73,000 yuan, with an average value of 795,000 yuan; these figures are about six and 60 times average household annual income, respectively.
Working Paper 5421
|Explaining variation in child labor statistics|
September 2010 - This paper presents the results from a randomized survey experiment in Tanzania focusing on two aspects of household surveys aimed at eliciting information on child labor: different questionnaire design to classify child work, and proxy response versus self-reporting. Use of a short module compared with a more detailed questionnaire has a statistically significant effect, especially on child labor force participation rates, and, to a lesser extent, on working hours. By contrast, proxy reports do not differ significantly from a child’s self-report.
Working Paper 5414
|Economic freedom, human rights, and the returns to human capital: an evaluation of the Schultz hypothesis|
August 2010 - According to T.W. Schultz, the returns to human capital are highest in economic environments experiencing unexpected price, productivity, and technology shocks that create "disequilibria." This paper tests the hypothesis that the returns to skills are highest in countries that allow individuals to respond to shocks. Using estimated returns to schooling and work experience from 122 household surveys in 86 developing countries, this paper demonstrates a strong positive correlation between the returns to human capital and economic freedom, an effect that is observed throughout the wage distribution. Economic freedom benefits those workers who have attained the most schooling as well as those who have accumulated the most work experience.
Working Paper 5405
|A control function approach to estimating dynamic probit models with endogenous regressors, with an application to the study of poverty persistence in China|
August 2010 - This paper proposes a parametric approach to estimating a dynamic binary response panel data model that allows for endogenous contemporaneous regressors. This approach is of particular value for settings in which one wants to estimate the effects of an endogenous treatment on a binary outcome. An application of the method shows that migration within China is important for reducing the likelihood that poor households remain in poverty and that non-poor households fall into poverty; failure to control for unobserved heterogeneity leads to an underestimation of these effects.
Working Paper 5400
|Experimental approaches in migration studies |
August 2010 - The decision of whether or not to migrate has far-reaching consequences for the lives of individuals and their families. But the very nature of this choice makes identifying the impacts of migration difficult, since it is hard to measure credibly what the person and their household would have been doing had migration not occurred. Migration experiments provide a clear and credible way for identifying this counterfactual, and thereby allowing causal estimation of the impacts of migration. The authors provide an overview and critical review of the three strands of this approach: policy experiments, natural experiments, and researcher-led field experiments.
Working Paper 5395
|The economic consequences of "brain drain" of the best and brightest: microeconomic evidence from five countries |
August 2010 - Brain drain has long been a concern for migrant-sending countries, particularly for small countries where high-skilled emigration rates are highest. But while economic theory suggests both benefits and costs from skilled emigration, the evidence base on these is very limited. This paper presents the results of innovative surveys that tracked academic high-achievers from five countries to wherever they moved in the world. Thanks to these surveys, the paper is able to present detailed micro-level measurements of how high-skilled emigration affects both the migrants and the sending country—in terms of income, education, remittances, trade and FDI, knowledge-sharing, and fiscal costs.
Working Paper 5394
|On Measuring Scientific Influence |
July 2010 - Bibliometric measures based on citations are widely used in assessing the scientific publication records of authors, institutions and journals. Yet currently favored measures lack a clear conceptual foundation and are known to have counter-intuitive properties. The authors propose a new approach grounded on a theoretical "influence function" that embodies explicit prior beliefs about how citations reflect influence. They provide conditions for robust qualitative comparisons of influence -- conditions that can be implemented using readily available data. An example is provided using the economics publication records of selected universities and the World Bank.
Working Paper 5375
|The World Bank’s Publication Record |
July 2010 - The World Bank has produced a huge volume of books and papers on development -- 20,000 publications spanning decades. This paper finds evidence that many of these publications have influenced development thinking, as indicated by the citations found using Google Scholar and bibliographic data bases. However, a non-negligible share of the Bank's publications have received no citations, though they may well have influenced non-academic audiences. Individually authored journal articles have been the main channel for scholarly influence. The Bank produces more research output on development than do other international agencies or top universities, while the quality and influence of these Bank publications equal or exceed those of most top universities.
Working Paper 5374
|Child ability and household human capital investment decisions in Burkina Faso|
July 2010 - Using data they collected in rural Burkina Faso, the authors examine how children's cognitive abilities influence resource-constrained households' decisions to invest in their education. This paper uses a direct measure of child ability for all primary school-aged children (regardless of enrollment), and it also uses measures of siblings’ ability, to test how sibling rivalry affects parents’ decisions on investing in education of their child. The findings indicate that children with one standard deviation higher ability are 16 percent more likely to be currently enrolled, but that having a higher-ability sibling reduces the likelihood of enrollment by a similar amount.
Working Paper 5370
|Education, labor rights, and incentives: contract teacher cases in the indian courts|
July 2010 - Since the early 1990s, the Indian government has increasingly employed contract workers to perform state functions, including teaching. Yet little research has been done on how courts have reacted to this policy shift. This paper looks at all relevant cases in the Indian Supreme Court and four High Courts over the last thirty years, and finds that the judiciary has increasingly become less sympathetic to contract teachers’ demands. The paper argues that the Court could use judicial review to engage the government and guide the creation of a labor policy that achieves a better school system for students and teachers.
Working Paper 5365
|The Global Financial Crisis and Development Thinking|
June 2010 - The global financial crisis has not only dealt a major blow to the global economy, but also shaken confidence in economic management in the developed world and the economic models that guide it. The crisis has revealed major market failures, especially in the housing bubble and its transmission to the financial system, but also glaring state failures that propagated and exacerbated the crisis. Will the events of the past two years lead to major shifts in thinking about development economics, and should they? This paper assesses that question for several key domains of development thinking, including the market-state balance, macroeconomic management, globalization, development financing, and public spending.
Working Paper 5353
|China's Marriage Market and Upcoming Challenges for Elderly Men|
June 2010 - Fertility decline has fueled a sharp increase in the proportion of 'missing girls' in China, so an increasing share of males will fail to marry, and will face old age without the support normally provided by wives and children. This paper shows that historically, China has had nearly-universal marriage for women and a very competitive market for men. Lower-educated men experience higher rates of bachelorhood while women favor men with better prospects, migrating if needed from poorer to wealthier areas. The authors examine the anticipated effects of this combination of bride shortage and hypergamy, for different regions of China.
Working Paper 5351
|Political Capture of Decentralization: Vote-Buying through Grants-Financed Local Jurisdictions|
June 2010 - A recent trend in decentralization in several large and diverse countries is the creation of local jurisdictions below the regional level -- municipalities, towns, and villages -- whose spending is almost exclusively financed by grants from both regional and national governments. This paper argues that such grants-financed decentralization enables politicians to target benefits to pivotal voters and organized interest groups in exchange for political support. Decentralization, in this model, is subject to political capture, facilitating vote-buying, patronage, or pork-barrel projects, at the expense of effective provision of broad public goods. The paper explores the theory's implications for international development programs in support of decentralization.
Working Paper 5350
|The Publicity “Defect” of Customary Law|
June 2010 - This paper examines the extent to which dispute resolvers in customary law systems provide widely understandable justifications for their decisions. The paper first examines the liberal-democratic reasons for the importance of publicity, understood to be wide accessibility of legal justification, by reviewing the uses of publicity in Habermas’ and Rawls’ accounts of the rule of law. Taking examples from Sierra Leone, the paper then argues that customary law systems would benefit from making the reasons for local dispute resolution practices, such as "begging" from elders, witchcraft, and openness of hearings, more widely accessible. The paper concludes that although legal pluralism is usually taken to be an analytical concept, it may have a normative thrust as well, and that publicity standards would also apply to formal courts in developing countries, which are also typically "defective" along this dimension.
Working Paper 5349
|Are health shocks different? evidence from a multi-shock survey in Laos|
June 2010 - In Laos health shocks are more common than most other shocks and more concentrated among the poor. They tend to be more idiosyncratic than non-health shocks, and are more costly, leading to high medical expenses and sizeable income losses. Health shocks also stand out from other shocks in the number of coping strategies they trigger, and in terms of households being forced to cut back consumption and affecting a family's well-being "a lot." Household members experiencing a health shock did not recover their former subjective health following the health shock, losing, on average, 0.6 points on a 5-point scale.
Working Paper 5335
Access to Water, Women's Work and Child Outcomes
May 2010 - Taking into account the nonrandom placement of water infrastructure, and using survey data from nine developing countries, this paper finds that access to water does not lead to increased off-farm work for women. However, in countries where substantial gender gaps in schooling exist, both boys' and girls' enrollments improve with better access to water. There are also some signs of impacts on child health as measured by anthropometric z-scores.
Working Paper 5302
|Aid Quality and Donor Rankings|
May 2010 - This paper presents an overall aid quality index and four coherently defined sub-indexes on aid selectivity, alignment, harmonization, and specialization. Compared with earlier indicators used in donor rankings, the indicator set developed is more comprehensive and representative of the range of donor practices addressed in the 2005 Paris Declaration on Aid Effectiveness, improving the validity, reliability, and robustness of rankings. One of the innovations is to increase the validity of the aid quality indicators by adjusting for recipient characteristics, donor aid volumes, and other factors. Despite these improvements in data and methodology, the authors caution against overinterpretation on overall indexes such as these.
Working Paper 5290
|Cash or Condition? Evidence from a Randomized Cash Transfer Program|
March 2010 - Are the large enrollment effects of Conditional Cash Transfer (CCT) programs a result of the conditions or simply the cash? This paper presents the first experimental evidence on the effectiveness of conditionality in cash transfer programs for schooling. Using data from an intervention in Malawi that featured randomized conditional and unconditional treatment arms, the authors find that the program reduced the dropout rate by more than 40% and substantially increased regular school attendance among the target population of adolescent girls. However, the authors do not detect a higher impact in the conditional treatment group. This finding contrasts with previous non-experimental studies of CCT programs, which found negligible "income" effects and strong "price" effects on schooling. The authors argue that their findings are consistent with the very low level of incomes and the high prevalence of teen marriage in the region.
Working Paper 5259
|Benefit Incidence Analysis: Are Government Health Expenditures More Pro-rich Than We Think?|
March 2010 - It is generally accepted that government health expenditures should disproportionately benefit the poor. And yet in most developing countries the opposite is the case. This paper examines the implications of a central assumption of benefit incidence analysis, namely that the unit cost of a government-provided service bears no relation to the out-of-pocket payments paid by the patient. It argues that a more plausible assumption is that larger out-of-pocket payments for a given unit of utilization reflect more (or more costly) services being delivered. The paper shows that this second more realistic assumption is likely to make government spending on health appear more pro-rich than the traditional constant-cost assumption.
Working Paper 5234
A New Approach to Producing Geographic Profiles of HIV Prevalence: An Application to Malawi
January 2010 - This paper proposes a new approach to the estimation of HIV prevalence for relatively small geographic areas in settings where national population-based surveys of prevalence are not available. The proposed approach, which uses small-area estimation (SAE) methods, aims to overcome some of the difficulties with prevailing methods of deriving HIV prevalence estimates (at both national and sub-national levels) directly from sentinel surveys. The paper illustrates the methods in the case of Malawi where the adult prevalence is estimated to be the eighth highest in the world. The paper is the first time that SAE methods have been applied to HIV prevalence data.
Working Paper 5207
| ||Do Labor Statistics Depend on How and to Whom the Questions Are Asked? Results from a Survey Experiment in Tanzania|
January 2010 - Labor market statistics are critical for assessing and understanding economic development. In practice, widespread variation exists in how labor statistics are measured in household surveys in low-income countries. Little is known whether these differences have an effect on the labor statistics they produce. This paper analyzes these effects by implementing a survey experiment in Tanzania that varied two key dimensions: the level of detail of the questions and the type of respondent. Significant differences are observed across survey designs with respect to different labor statistics.
Working Paper 5192
International aid and financial crises in donor countries
December 2009 - The global financial crisis has already led to sharp downturns in the developing world. In the past, international aid has been able to offset partially the effects of crises that began in the developing world, but because this crisis began in the wealthy countries, donors may be less willing or able to increase aid in this crisis. Using panel data from 24 donor countries between 1977 and 2007, this paper finds that banking crises in donor countries have been associated with substantial additional reductions in aid flows, beyond any income-related effects, perhaps because of the high fiscal costs of crisis and the debt hangover in the post-crisis periods. The results also confirm that donor-country incomes are robustly related to per-capita aid flows. Because donor countries are being hit hard by the current global recession and several have also suffered banking-sector crises, aid is likely to fall by a significant amount (relative to the counterfactual) in the coming years.
Working Paper 5162
U.S. and them: the geography of academic research
December 2009 - Using a database of 76,046 empirical economics papers published between 1985 and 2004 in the top 202 economics journals, the authors report two associations. First, controlling for the availability and quality of data in the country, and indicators of governance, per-capita research output on a given country increases with the country's per capita gross domestic product (the elasticity is around 0.4). Surprisingly, the United States (US) is not an outlier in this relationship. Second, papers written about the U.S. are around 2.5 percentage points more likely to be published in the top-five economics journals, even after partially controlling for the quality of research.
Working Paper 5152
Family systems, political systems, and Asia's ‘missing girls’: the construction of son preference and its unraveling
December 2009 - Son preference is known to be found in certain types of cultures, that is patrilineal cultures. But what explains the fact that China, South Korea, and Northwest India manifest such extreme child sex ratios compared with other patrilineal societies? This paper argues that what makes these societies unique is that their pre-modern political and administrative systems used patrilineages to organize and administer their citizens. The interplay of culture, state, and political processes generated uniquely rigid patriliny and son preference. The paper also argues that the advent of the modern state in these settings has unraveled the underpinnings of the rigid patrilineal rules, and unleashed a variety of forces that reduce son preference.
Working Paper 5148
|What did you do all day? Maternal education and child outcomes|
November 2009 - New research from Pakistan suggests that mothers with some education spend 75 minutes more on educational activities at home (including helping with schoolwork) than mothers with no education. Children whose mothers have some education achieve higher test scores in English, Urdu and mathematics than children whose mothers have no education. Mothers with some education do not, however, seem to have greater bargaining power within their household. Education therefore seems to affect how mothers value their children’s education.
Working Paper 5143
How might India's public health systems be strengthened?
November 2009 - India’s central government’s policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the health ministry's capacity for stewardship of the nation's public health. It also discusses approaches to strengthening the public health system, including linking central government fiscal support to states to progress in four areas, such as having states establish of separate public health directorates.
Working Paper 5140
Mental Health in the Aftermath of Conflict
November 2009 - Assessments of the mental health consequences of conflict face a number of challenges: lack of validated mental health scales in a survey context; difficulties in measuring individual exposure to conflict; and issues related to making causal inferences from observed correlations. The authors illustrate how some of these issues can be overcome in a study of mental health in post-conflict Bosnia and Herzegovina. They measure mental health using a clinically validated scale, and exposure to conflict through administrative data on war casualties. They find no significant relationship between the two.
Working Paper 5132
Comparing condom use with different types of partners : evidence from national HIV surveys in Africa
November 2009 - Based on nationally representative samples from 13 Sub-Saharan African countries, this paper finds that condom use in general is low in this region. It also finds that in general men report using condoms more frequently than women, and that unmarried individuals report they use condoms more frequently than married individuals with their spouse. The paper discovers a gender difference in relation to condom use with extramarital partners: married men use condoms with extramarital partners about as frequently as unmarried men; however, married women use condoms with extramarital partners less frequently than unmarried women.
Working Paper 5130
The association between remarriage and HIV infection: new evidence from national HIV surveys in Africa
November 2009 - It is known that divorced, separated, and widowed individuals in Africa are at significantly increased risk for HIV. This paper shows that remarried individuals are typically a larger group than the divorced, separated, or widowed, and furthermore also have higher-than-average HIV prevalence. This large number of high-risk remarried individuals is an important source of vulnerability and further infection that needs to be acknowledged and taken into account in prevention strategies.
Working Paper 5118
Public interest litigation in India: overreaching or underachieving?
November 2009 - Public interest litigation has historically been an innovative judicial procedure for enhancing the social and economic rights of disadvantaged and marginalized groups in India. This paper finds that public interest litigation cases constitute less than 1 percent of the overall case load. It argues that complaints about public interest litigation related to concerns having to do with separation of powers are better understood as criticisms of the impact of judicial interventions on sector governance. The paper finds that win rates for fundamental rights claims are significantly higher when the claimant is from an advantaged social group than when he or she is from a marginalized group, which constitutes a social reversal, both from the original objective of public interest litigation and from the relative win rates in the 1980s.
Working Paper 5109
How do local-level legal institutions can promote development
November 2009 - Local-level, informal legal institutions can support social substitutes for the enforcement of contracts, although these substitutes tend to be limited in range and scale. They are flexible and could be adapted to serve the interests of the poor and marginalized if supportive organizational and social resources could be brought to support the legal claims of the disempowered. They are, however, more likely to support personal integrity rights than the positive liberties that are also constitutive of development as freedom.
Working Paper 5108
|Left behind to farm? women's labor re-allocation in rural China|
October 2009 - Left-behind women find the extra hours of farm work either by reducing hours devoted to wage work and family businesses or (in the case of older women) by reducing their leisure time. In general, these time-allocation effects are associated primarily with the migration of offspring as opposed to husbands, and are not reversed when migrants return, with seemingly permanent consequences. No effects on health or empowerment were detected.
Working Paper 5107
Designing Cost-Effective Cash Transfer Programs to Boost Schooling among Young Women in Sub-Saharan Africa
October 2009 - Little is known about how the design of cash transfer programs affects their impacts. This paper presents one-year schooling impacts from a conditional cash transfer experiment among teenage girls and young women in Malawi, and explores how impacts vary depending on the way the program was designed. Overall, the program had large impacts on school attendance: the re-enrollment rate among those who had already dropped out of school before the start of the program increased by two and a half times and the dropout rate among those in school at baseline decreased from 11 to 6 percent. The impacts were similar irrespective of whether cash transfers were conditional on enrollment. When cash sums were given to parents, schooling outcomes were not affected by the program, even for large when transfers. However, when the cash was given directly to the girls, higher transfers were associated with significantly improved school attendance and progress, but only if the transfers were conditional on school attendance.
Working Paper 5090
Conditional cash transfers for school attendance can reduce teenage pregnancies and early marriage as well as increase enrollment
October 2009 - Malawi’s Zomba Cash Transfer Program is randomized and targets young women. It provides incentives (in the form of school fees and cash transfers, equivalent to US$10/month) to current schoolgirls and recent dropouts to stay in or return to school. The program has led to significant declines in early marriage, teenage pregnancy, and self-reported sexual activity among program beneficiaries after just one year of implementation. For program beneficiaries who were out of school at baseline, the probability of getting married and becoming pregnant declined by more than 40 percent and 30 percent, respectively. In addition, the incidence of the onset of sexual activity was 38 percent lower among all program beneficiaries than the control group.
Working Paper 5089
Demographic and socioeconomic patterns of HIV/AIDS prevalence in Africa
October 2009 - Understanding the demographic and socioeconomic patterns of the prevalence and incidence of HIV/AIDS in Sub-Saharan Africa is crucial for developing programs and policies to combat HIV/AIDS. This paper shows how weak the evidence base is on the subject, reflecting problems surrounding definitions, samples, and empirical methods. The paper concludes that there are few consistent and significant patterns of prevalence by socioeconomic and demographic status.
Working Paper 5076 | Research Digest (Fall)
How to improve public health systems: lessons from Tamil Nadu
October 2009 - Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs. Tamil Nadu chose the opposite course. This paper describes its public health system, and argues that Tamil Nadu’s separate and strong public health system has helped it conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. Tamil Nadu’s health indicators are better than those of other states, despite its limited government health expenditure.
Working Paper 5073
|Do value-added estimates add value? accounting for learning dynamics|
September 2009 - Standard evaluation methods in education use so called "value-added" models, which assume perfect persistence across years. In contrast, new econometric methods show that only one-fifth to a half of a student's achievement persisted from one grade to the next. The authors find no learning advantage of private over public schools using traditional value-added measures of learning but a large gain (equivalent to the test score gain between third and fourth grade) when persistence is accurately measured.
Working Paper 5066
|How many more infants are likely to die in Africa as a result of the global financial crisis?|
August 2009 - This is the main result of a new working paper by Jed Friedman and Norbert Schady, who also estimate that most of the additional deaths will be in rural areas and among households with limited education. Girls, they estimate, will be disproportionately affected. The authors urge policies to protect the incomes of poor households, the maintenance of critical health services, and interventions targeted at female infants and young girls.
Working Paper 5023
Aid and trust in country systems
July 2009 - In a new working paper, Stephen Knack and Nicholas Eubank conclude from their empirical cross-country analysis that donors’ trust in recipient country systems is positively related to: the trustworthiness or quality of those systems; tolerance for risk on the part of the donor’s constituents, as measured by public support for providing aid; and the donor’s ability to internalize more of the benefits of investing in country systems, as measured by the donor’s share of all aid provided to a recipient.
Working Paper 5005
Own and sibling effects of conditional cash transfer programs: theory and evidence from Cambodia
July 2009 - Conditional cash transfers have been adopted by a large number of countries in the past decade. Although the impacts of these programs have been studied extensively, understanding of the economic mechanisms through which cash and conditions affect household decisions remains incomplete. This paper uses evidence from a program in Cambodia, where eligibility varied substantially among siblings in the same household, to illustrate these effects. A model of schooling decisions highlights three different effects of a child-specific conditional cash transfer: an income effect, a substitution effect, and a displacement effect. The model predicts that such a conditional cash transfer will increase enrollment for eligible children - due to all three effects - but have an ambiguous effect on ineligible siblings. The ambiguity arises from the interaction of a positive income effect with a negative displacement effect. These predictions are shown to be consistent with evidence from Cambodia, where the child-specific program makes modest transfers, conditional on school enrollment for children of middle-school age. Scholarship recipients were more than 20 percentage points more likely to be enrolled in school and 10 percentage points less likely to work for pay. However, the school enrollment and work of ineligible siblings was largely unaffected by the program.
Working Paper 5001
|Are there diminishing returns to transfer size in conditional cash transfers?|
July 2009 - There is increasing evidence that conditional cash transfer programs can have large impacts on school enrollment, including in very poor countries. However, little is known about which features of program design -- including the amount of the cash that is transferred, how frequently conditions are monitored, whether non-complying households are penalized, and the identity or gender of the cash recipients -- account for the observed outcomes. This paper analyzes the impact of one feature of program design -- namely, the magnitude of the transfer. The analysis uses data from a program in Cambodia that deliberately altered the transfer amounts received by otherwise comparable households. The findings show clear evidence of diminishing marginal returns to transfer size despite the fact that even the larger transfers represented on average only 3 percent of the consumption of the median recipient households. If applicable to other settings, these results have important implications for other programs that transfer cash with the explicit aim of increasing school enrollment levels in developing countries.
Working Paper 4999
|Programs that promote school enrollment may not result in learning: Cambodia's experience with a scholarship program suggests why|
July 2009 - In a new working paper, Deon Filmer and Nobert Schady estimate a 25% increase in enrollment as the result of the program, but obtain negligible impacts —18 months after the scholarships were awarded—on mathematics and vocabulary test scores. They explain their findings in terms of self-selection by low-ability students into school as the result of the scholarship program, and suggest that such programs may need to make special efforts to address the learning difficulties of low-ability students.
Working Paper 4998
System-wide impacts of hospital payment reforms: evidence from central and eastern Europe and central Asia
July 2009 - Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on "amenable mortality," but there were significant impacts for only a couple of causes of death, and not in all model specifications.
Working Paper 4987
Educational and health impacts of two school feeding schemes: evidence from a randomized trial in rural Burkina Faso
June 2009 - This paper uses a prospective randomized trial to assess the impact of two school feeding schemes on health and education outcomes for children from low-income households in northern rural Burkina Faso. The two school feeding programs under consideration are, on the one hand, school meals where students are provided with lunch each school day, and, on the other hand, take-home rations that provide girls with 10 kg of cereal flour each month, conditional on 90 percent attendance rate. After running for one academic year, both programs increased girls’ enrollment by 5 to 6 percentage points. While there was no observable significant impact on raw scores in mathematics, the time-adjusted scores in mathematics improved slightly for girls. The interventions caused absenteeism to increase in households that were low in child labor supply while absenteeism decreased for households that had a relatively large child labor supply, consistent with the labor constraints. Finally, for younger siblings of beneficiaries, aged between 12 and 60 months, take-home rations have increased weight-for-age by .38 standard deviations and weight-for-height by .33 standard deviations. In contrast, school meals did not have any significant impact on the nutrition of younger children.
Working Paper 4976
Do international treaties promote development? the convention on the rights of the child and basic immunization
June 2009 - Little evidence is available on whether changing global rules so as to promote human rights can enhance development outcomes. The Convention on the Rights of the Child was almost universally ratified by the mid-1990s, but it is unclear whether treaty ratification was associated with better or wider protection of children’s rights. This paper uses an instrumental variable approach to investigate whether treaty ratification was associated with stronger effort at the country level on child survival, and particularly with higher rates of immunization coverage. The paper finds that ratification of the Convention on the Rights of the Child was correlated with a subsequent increase in immunization rates, but only in upper middle and high-income countries. Treaties can promote development outcomes, but require institutional support to do so.
Working Paper 4964
How can donors help build global public goods in health?
April 2009 - Aid to developing countries has largely neglected the population-wide health services that are core to communicable disease control in the developed world. These mostly non-clinical services generate "pure public goods" by reducing everyone's exposure to disease through measures such as implementing health and sanitary regulations. They complement the clinical preventive and treatment services which are the donors' main focus. Their neglect is manifested, for example, in a lack of coherent public health regulations in countries where donors have long been active, facilitating the spread of diseases such as avian flu. These services can be inexpensive, and dramatically reduce health inequalities. Sri Lanka spends less than 0.2% of GDP on its well-designed population-wide services, which contribute to the country's high levels of health equity and life expectancy despite low GDP per head and civil war. Evidence abounds on the negative externalities of weak population-wide health services. Global public health security cannot be assured without building strong national population-wide health systems to reduce the potential for communicable diseases to spread within and beyond their borders. Donors need greater clarity about what constitutes a strong public health system, and how to build them. The paper discusses gaps in donors' approaches and first steps toward closing them.
Working Paper 4907
Orphanhood and the living arrangements of children in sub-saharan Africa
March 2009 - Increasing adult mortality due to HIV/AIDS in Sub-Saharan Africa raises considerable concerns about the welfare of surviving children. Studies have found substantial variability across countries in the negative impacts of orphanhood on child health and education. One hypothesis for this variability is the resilience of the extended family network in some countries to care for orphans-networks under increasing pressure by the sheer number of orphans in many settings. Using household survey data from 21 countries in Africa, this study examines trends in orphanhood and living arrangements, and the links between the two. The findings confirm that orphanhood is increasing, although not all countries are experiencing rapid rises. In many countries, there has been a shift toward grandparents taking on increased childcare responsibility-especially where orphan rates are growing rapidly. This suggests some merit to the claim that the extended network is narrowing, focusing on grandparents who are older and may be less able to financially support orphans than working-age adults. However there are also changes in childcare patterns in countries with stable orphan rates or low HIV prevalence. This suggests future work on living arrangements should not exclude low HIV/AIDS prevalence countries, and explanations for changes should include a broader set of factors.
Working Paper 4889
The demographic and socio-economic distribution of excess mortality during the 1994 genocide in Rwanda
March 2009 - There is an extensive literature on violent conflicts such as the 1994 Rwandan genocide, but few papers examine the profiles of victims and perpetrators, or more broadly the micro-level dynamics of widespread violence. This paper studies the demographic consequences of the Rwandan genocide and how the excess mortality due to the conflict was distributed in the population. Data collected by the 2000 Demographic and Health Survey indicate that although there were more deaths across the entire population, adult males were the most likely to die. Using the characteristics of the survey respondent as a proxy for the socio-economic status of the family dead, the results also show that individuals with an urban or more educated background were more likely to die. Over and above the human tragedies, a long-term cost of the genocide is the country's loss of productive skills.
Working Paper 4850
No more cutting class ? reducing teacher absence and providing incentives for performance
February 2009 - Expanding and improving basic education in developing countries requires, at a minimum, teachers who are present in the classroom and motivated to teach, but this essential input is often missing. This paper describes the findings of a series of recent World Bank and other studies on teacher absence and incentives for performance. Surprise school visits reveal that teachers are absent at high rates in countries such as India, Indonesia, Uganda, Ecuador, and Zambia, reducing the quality of schooling for children, especially in rural, remote, and poor areas. More broadly, poor teacher management and low levels of teacher accountability afflict many developing-country education systems. The paper presents evidence on these shortcomings, but also on the types of incentives, management, and support structures that can improve motivation and performance and reduce avoidable absenteeism. It concludes with policy options for developing countries to explore as they work to meet Education for All goals and improve quality.
Working Paper 4847
Is there an incipient turnaround in Asia's "missing girls" phenomenon?
February 2009 - The apparently inexorable rise in the proportion of "missing girls" in much of East and South Asia has attracted much attention amongst researchers and policy-makers. An encouraging trend was suggested by the case of South Korea, where child sex ratios were the highest in Asia but peaked in the mid-1990s and normalized thereafter. Using census data, we examine whether similar trends have begun to manifest themselves in the two large populous countries of this region, China and India. The data indicate that child sex ratios are peaking in these countries, and in many sub-national regions are beginning to trend towards less masculinization. This suggests that, with continuing vigorous efforts to reduce son preference, the "missing girls" phenomenon could be addressed in Asia.
Working Paper 4846
Social health insurance vs. tax-financed health systems - evidence from the OECD
January 2009 - This paper exploits the transitions between tax-financed health care and social health insurance in the OECD countries over the period 1960-2006 to assess the effects of adopting social health insurance over tax finance on per capita health spending, amenable mortality, and labor market outcomes. The paper uses regression-based generalizations of difference-in-differences and instrumental variables to address the possible endogeneity of a country's health system. It finds that adopting social health insurance in preference to tax financing increases per capita health spending by 3-4 percent, reduces the formal sector share of employment by 8-10 percent, and reduces total employment by as much as 6 percent. For the most part, social health insurance adoption has no significant impact on amenable mortality, but for one cause-breast cancer among women-social health insurance systems perform significantly worse, with 5-6 percent more potential years of life lost.
Working Paper 4821