Down the River: Glyphosate Use in Agriculture and Birth Outcomes of Surrounding Populations (with Rudi Rocha and Rodrigo Soares) - Review of Economic Studies (Forthcoming)
This paper documents an externality from the agricultural use of the most widely applied herbicide in the world---glyphosate---on birth outcomes of surrounding populations. We focus on the subclinical effects of water contamination in areas distant from the original locations of application. Our identification relies on: (i) the regulation allowing the introduction of genetically modified seeds in Brazil; (ii) the potential gain in municipality-level productivity from adoption of genetically modified soybean seeds and the strong complementary between these seeds and glyphosate; and (iii) the direction of water flow within water basins. We document a significant deterioration in birth outcomes for populations downstream from locations that are likely to have increased relatively more the use of glyphosate. According to our preferred specification, the average increase in glyphosate use in the sample during the 2000-2010 period led to an increase of 5% of the average in the infant mortality rate.
The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil (with Luiz Felipe Fontes) - American Economic Journal: Economic Policy (Forthcoming)
This paper studies the 2002 Brazilian Psychiatric Reform, which reorganized the public mental healthcare provision by introducing Psychosocial Care Centers (CAPS) as a community-based substitute for inpatient care. Our research design exploits the roll-out of CAPS in a difference-in-differences framework. We show that these centers increased the outpatient mental healthcare production and were effective in reducing hospitalizations due to mental and behavioral disorders. These reductions were more pronounced for long-stay admissions and among patients with schizophrenia. We find that the implied savings from less admissions does not totally offset the cost of the policy. Also, the reform had no effects on mental health mortality, but increased violent crime.
Pooling is a widely used mechanism in regulated selection markets to contain price inflation and improve stability. I study one such regulatory change introduced by the Brazilian private health insurance market regulatory agency. The rule affects small group contracts, mainly provided by employers, and forces insurers to apply the same premium percentage change to every pooled contract. I leverage a unique dataset with premium percentage changes for all group contracts in Brazil and exploit a discontinuity with respect to the number of enrollees in each contract to identify the effect over premium changes of being pooled versus negotiating such adjustment. My results indicate that contracts with bargained changes experience premium increases about 13% lower. This difference is driven by differences in bargaining power between the two situations rather than differences in costs and not-for-profit insurers do not seem to take full advantage of their bargaining power. Finally, I show evidence suggesting that this particular pooling strategy, if anything, seems to generate low benefits accrued by contracts that would likely benefit from bargaining with insurers.
We use data on the price of nursing home private rooms to estimate the effects of aging on long-term care (LTC) prices. We exploit regional variation in the dynamics of elderly population growth rates generated by the demographic composition in the distant past. We estimate a cross-region elasticity of LTC prices to the number of people aged 75 and more of 0.6. We argue that this cross-sectional estimate is robust to the presence of heterogeneous treatment effects and is a lower bound for the national estimate; thus, population aging explains at least 38% of the last decade's real increase in LTC price, and it will increase prices in 18% during the next decade. We study the mechanism behind our results and find evidence that regulation and the organization of industry, not the inelastic supply of nurses, is driving the increase in LTC prices.
Health insurance markets with a public option typically feature rules tying premiums to incomes. These rules may distort agents' choices and affect the market in meaningful ways but are understudied by the literature despite being widespread. In this paper, I study the Chilean health insurance market to understand how its rules distort incentives, the consequences for the public option, and how it may interact with the rapid income growth that, like other Latin American nations, the country has been experiencing. Through a structural model of health insurance choices and spending decisions, I find that the institutional setting in Chile allows private insurers to effectively screen out poor sick agents who do not generate profits. I also simulate how demand for plans and medical spending would change when incomes grow, showing that agents more likely to switch to private plans are not excessively costly to cover but generate low revenues and reduce the profit margins of private plans. On the other hand, the public option benefits substantially from income growth, reducing their financial deficit. Moreover, the distribution of income growth matters, with the effects being stronger when poorer agents accrue a higher share of this growth.
Work in Progress
Effects of Changes in Health Plan Networks