- (Working Paper) The Effect of Copayments on Children’s and Adolescents’ Use of Medical Care
(with Anton Nilsson) [PDF] [Online Appendix] [PDF+Online Appendix]
We exploit a policy change in Sweden to estimate the effect of cost-sharing on the demand for children’s and adolescents‘ use of medical care. To this end, we use a large population-wide registry data set including detailed information about individuals and their contacts with the health care system. The reform we study was unexpected and came into effect in January 2002. It abolished copayments in outpatient care for children between 7 and 19 years. We estimate a difference-in-differences model using age groups slightly younger and slightly older as controls. When care became free of charge, we find that individuals increased their number of visits to a doctor by 5-10 percent. Effects are similar across age groups but vary substantially by income, with children from low-income families being three times as responsive as their more advantaged peers. We also exploit the fact that copayments charged changed discontinuously at age 7 before the reform and at age 20 after the reform. Estimating a regression discontinuity design around these two age thresholds, we obtain very similar estimates to the ones from the difference-in-differences model, thus adding to the overall credibility of our results. Our findings provide one explanation for the widely-observed gradient in child health with respect to parental income. Given the far-reaching effects of child health on outcomes in adulthood, cost-sharing for children warrants careful consideration.
- (Working Paper) Parental Unemployment and Newborn Health (with Gerard van den Berg and Steffen Reinhold) [PDF]
Previous literature speculated that economic downturns are beneficial to health outcomes of newborn infants in developed countries. In this paper, we address this question with a dataset from Sweden over the time period 1992-2004. We find that a one-percentage-point increase in the unemployment rate during pregnancy reduces the probability of having a birth weight less than 1,500 grams or of dying within 28 days of birth by 6-11 percent. We take a rigorous econometric approach that only uses regional variation in unemployment and compares babies born to the same parents so as to address selective fertility based on labor market conditions. Thanks to detailed information about the parents, we are also able to elucidate the channels linking downturns to newborn health. We find that improvements in health cannot be attributed to the father’s or mother’s employment status. However, we provide evidence that higher unemployment particularly benefits infants of parents with low socio-economic status and that it reduces the incidence of premature birth. Both findings are consistent with certain channels independent of parents‘ employment status, such as reductions in stress and air pollution.
- (Working Paper) The Role of Low Birth Weight Thresholds in the Absence of Regulatory Incentives: Evidence from Sweden (with Hans-Martin von Gaudecker)