The Incidence of Public Subsidies to Private Hospitals under Weak Governance: Evidence from India (joint with Radhika Jain)

Expanding public health insurance and enlisting private agents for service delivery are common policy strategies to meet the goals of universal health coverage, but there is limited evidence from developing countries to inform their design. This paper, joint with Radhika Jain from Harvard School of Public Health, provides quantitative evidence on how insurance design affects program performance and incidence in the context of a government-funded health insurance program that aims to provide free care to 46 million people in Rajasthan, India. We exploit a policy-induced natural experiment, and use administrative claims linked to patient surveys, to provide the first large-scale evidence of private hospital behavior under public health insurance.

Essays in Education and Crime in Colombia

This dissertation contains three essays in applied microeconomics. In the first chapter paper, I test whether the return to college education is the result of human capital accumulation or instead reflects the fact that attending college signals higher ability to employers. The second chapter provides evidence that parental incarceration increases children’s educational attainment. Finally, in the third chapter I derive a new expression that extends the Local Average Treatment Effect concept, to a setting with two sources of unobserved treatment heterogeneity.

"Renal Relationships: Understanding Living Kidney Donor Relationship Patterns"

Abstract: Who do we turn to in times of need? Traditionally, social support research has shown a strong preference to rely on strong ties in these scenarios - often, even when weak ties might be better positioned to help. However, this conclusion has recently been challenged by Small (2017), who argues that people often rely on weak ties for emotional support in stressful times, preferring to avoid more complicated strong ties. This suggests that the types of ties we activate in times of need varies by the situation. In this study, we apply this framework to the study of living donor kidney transplantation (LDKT), effectively asking: How does this behavior differ when the stakes are potentially life and death? Using a variety of primary and secondary datasets, we compare the distribution of LDKT ties to the distribution of ties who would be likely able to help, then seek to explain these relative utilization patterns as a function of medical fundamentals, social/spatial relationships, and qualitative reasoning invoked by survey respondents. Our preliminary findings show that LDKT patterns are primarily driven by social relationship quality, and far less by medical fundamentals such as the potential donors' health or genetic relationship to the patient.

"Can Labor Market Discrimination Explain Racial Disparities in Schooling? Evidence from WWII"

Abstract: Can the racial gap in labor market earnings explain black-white disparities in the schooling of the next generation? To answer this, we exploit the large increase in labor demand in markets that received WWII defense industry contracts. This increase in labor demand combined with a policy that prohibited discrimination by race and ethnicity in the defense industries resulted in significant increases in African American earnings and declines in the racial gap in earnings between 1940 and 1950. This was achieved largely via occupational upgrading among African Americans into semi-skilled professions. In contrast with women, whose progress in the labor market was largely reversed in short order, this occupational upgrading persisted for African Americans. We argue that this persistence is consistent with declines in statistical discrimination. Moreover, we find that in these same labor markets, the next generation of African Americans invested relatively more in their human capital, as measured by greater years of schooling and a decline in the black-white schooling gap. We explore three reasons why reductions in the black white earnings gap might lead to reductions in the black white schooling gap of the next generation. First, this would relax the financial constraint faced by many African American families, allowing their children to remain in school longer. Second, occupational upgrading might have increased the returns to human capital among African Americans. Finally, there may be political responses that result in changes in public funding and provision of schooling and other public goods that affect the human capital accumulation of the next generation of African Americans. We find evidence consistent with the first explanation only. We conclude that efforts to further reduce the racial gap in schooling might consider labor market interventions.

A Century of Educational Inequality in the United States

Abstract: The “income inequality hypothesis” holds that rising income inequality affects the distribution of a wide range of social and economic outcomes. Research highlighting the sharp increase in educational inequality in recent decades has fuelled concerns that rising income inequality has had damaging consequences for equality of educational opportunity, even while other researchers have provided descriptive evidence at odds with the income inequality hypothesis. In this paper we track long-term trends in family income inequalities in college enrollment ("enrollment inequality") using all available nationally representative datasets for cohorts born between 1908 and 1995. We show that the trend in enrollment inequality moved in lockstep with the trend in income inequality over the past century. There is one exception to this general finding: for cohorts at risk of serving in the Vietnam War, enrollment inequality was high while income inequality was low. During this period, enrollment inequality was significantly higher for men than for women. Aside from this singular confounding event, evidence on a century of enrollment inequality establishes a strong association between income inequality and enrollment inequality, providing support for the view that rising income inequality is fundamentally changing the distribution of life chances.
Co-sponsored with the Social Stratification, Inequality and Mobility Working Group

Machine Learning for Causal Inference

Abstract: Given advances in machine learning over the past decades, it is now possible to accurately solve difficult non-parametric prediction problems in a way that is routine and reproducible. In this talk, I'll discuss how these machine learning tools can be rigorously integrated into observational study analyses, and how they interact with classical ideas around randomization, semiparametric modeling, double robustness, etc. When deployed carefully, machine learning enables us to develop statistical estimators that reflect the study design more closely than basic linear regression based methods.

Race, Culture and Health: Conceptual and Methodological Innovations

Abstract: Building a culture of health and achieving health equity requires that we engage cultural processes in a more meaningful way. Cultural processes and systems are commonly referenced in health inequity scholarship but empirical research generally lags behind this conceptual emphasis. I argue that employing a transdisciplinary approach to examining intersections of culture, structure and racism is a valuable analytical tool for understanding the production of social and racial inequities in health. In this talk, I’ll discuss conceptual work advancing the concept of “cultural racism” in relation to racial inequities in health and will also provide an overview of related empirical projects: 1) a laboratory experiment examining the effects of media-based racism on physiological, psychological and behavioral stress responses, 2) a data science project exploring ways to assess chronic exposure to media-based racism and possible links to population health and 3) the use of virtual reality to promote structural competence regarding the structural and cultural roots of racism. In lieu of a deep dive on a single project or paper, the presentation seeks to support a rich conversation about the need for conceptual and methodological innovation in service of better understanding and addressing racial inequities in health.

Diversity, Immigration, and Public Opinion in the U.S.

Abstract: What factors animate public opinion towards immigrants? A substantial literature has tested the impact of individual objective traits like education and job market status on immigration attitudes. In addition, researchers have explored the role of subjective factors like immigrants’ perceived impact on society. However, prior quantitative research has generally overlooked a key aspect: natives’ impressions of who immigrants are. Immigrants in the U.S. are increasingly diverse and evidence suggests that natives prefer certain types of immigrants. Yet, survey questions gauging immigration attitudes often refer to “immigrants” as if they were a single, homogenous group, which makes it hard to interpret survey takers’ answers. To fill this gap, we explore heterogeneity in subjective perceptions of immigrants and assess their attitudinal impacts. We systematically uncover these perceptions by using a Latent Class Analysis approach on a new set of survey items we developed. We find the presence of four different immigrant “archetypes” or multidimensional constellations of immigrant traits. These archetypes are shared across regions, social classes, and partisan lines and more powerfully predict immigration attitudes than typical independent variables used in extant research. Last, we discuss the theoretical and methodological implications of our findings.

Life after death: The scale and salience of mortality in sub-Saharan Africa

Abstract: Dramatic reductions in the infant and under-five mortality rates over the last half century are among the global health community’s most notable achievements. The trends are clear and the message is positive: the world today is healthier and safer for young people than it has ever been. Sub-Saharan African countries, in particular, have experienced some of the most dramatic reductions in early life mortality. However, the all-time low infant and under-five mortality rates conceal the pervasiveness by which contemporary populations experience the phenomenon of having an infant or under-five-year-old child die—a life event that can leave parents vulnerable in myriad ways. In this talk I will introduce new population measures that capture the scale at which infant and child deaths are experienced by and dispersed across mothers in contemporary African populations. I will then demonstrate the disadvantage mothers can experience following a child’s death, and will conclude by discussing how I am extending this research with a data collection project in rural Malawi.
Co-Sponsored with the Stratification, Inequality, and Mobility Working Group

Talking Left, Living Right: Education, Ethnicity & Family Stability in the Golden State

Abstract: California has a reputation as a vanguard for the kinds of progressive values—like expressive individualism, personal fulfillment, and tolerance—associated with the second demographic transition (SDT). The SDT is associated with less marriage and greater family instability, among other things. But it turns out that, when it comes to the practice of family life, California has more intact, married families than the nation as a whole. Why is this? We argue that California has a disproportionate share of Asians and especially immigrants, and these two groups are more likely to embrace a familistic way of life and reject SDT values. We also note that more educated Californians, while they embrace progressive values in theory and in public, are more likely to embrace and live out familistic values in their own private family lives. So, immigrants, Asians, and more educated Californians disproportionately make up the ranks of Californians who are living in intact, married families.

Biodemography of Fertility and Longevity Using the Utah Population Database

Abstract: There is growing awareness that fertility affects rates of aging, adult survival prospects, and the likelihood of reaching exceptionally old ages. Much of this work, including our own, has focused on women and their ages at last birth, a proposed biodemographic marker for rates of aging. This literature has given far less attention to men, the risk of specific causes of death, the role of early initiation of fertility and how these forces may change over historical time. We use the Utah Population Database to examine how fertility alters adult mortality risks. We give special attention the role of late age at last birth, but also the role of early and late ages first birth Increasing parity is associated with worse survival for women and better for men. This talk will also present the opportunities made possible by the Utah Population Database, a unique resource of 11 million persons comprising genealogies, vital and medical records, as well as demographic and spatial data.

Does Online Partisan Media Affect Attitudes and Behavior?

Abstract: In today's fragmented online media ecosystem, does exposure to political news through partisan media have a measurable effect on citizens' political attitudes and behavior? Or are these outlets merely preaching to the choir? And if such media effects exist, are they durable and homogeneous across political groups? To answer these questions, we conducted a pre-registered, randomized field experiment embedded in a nationally representative online panel survey. We incentivized participants to temporarily alter features of their information environment during the 2018 U.S. midterm election campaign. Subjects in the treatment groups were asked to change their default browser homepage to either FoxNews.com or HuffPost.com. Using web browsing data collected for our respondents, we find that our intervention exogenously and durably altered news consumption habits. We then evaluate how our treatment affected political attitudes, voting behavior, and civic knowledge, which we measure based on survey responses collected at periodic intervals after our intervention, up to one year later. Our results generally show negligible persuasive and agenda-setting effects, consistent with the minimal media effects hypothesis. However, we uncover a meaningful decrease in overall media trust among those exposed to Fox News and an increase in support for liberal immigration policies among those in the Huffington Post treatment group.

The Effect of Land Allotment on Native American Households During the Assimilation Era

Abstract: In the early twentieth century, the U.S. government broke up millions of acres of communally owned reservation lands and allotted them to individual Native American households. Households initially received land allotments with limited property rights (‘in trust’), and were incentivized to prove themselves “competent” in order to obtain full legal title (‘fee simple’) after a set period. Indian allotment thus had elements of a conditional transfer program aimed at assimilation. The policy was ended suddenly in 1934, locking in-trust land into its status in perpetuity. We link land allotment information to the universe of Native American households in the 1940 U.S. Census. We exploit quasi-random variation in being allotted as well as in securing the allotment in fee simple. Obtaining an allotment significantly increased the likelihood of living on a farm but not of working as a farmer, indicating that allottees leased out their land. Allotments also impacted wages and occupational rank. Surprisingly, allotment most significantly impacted educational attainment. We interpret education as a way of signalling “competency” to government agents. Obtaining the land in fee simple was associated with decreased likelihood of living on a farm and owning one’s home, evidence that many allottees sold their land once they were deemed competent and obtained title. The fee-simple effects were more pronounced within tribes whose ancestral tribal norms emphasized private over communal property, indicating a cultural determinant in how the wealth transfer was utilized. Consistent with this, households in tribes with traditions of private property also engaged in more signalling of their assimilation.

Structural Racism and the People’s Health: History and Context Matters

Abstract: In this presentation on “Structural racism & the people’s health: history & context matters,” I commence with a brief reminder as to our current societal and ecological context, after which I introduce the ecosocial theory of disease distribution, which guides my work, including conceptualization and measurement of structural injustice. I then offer empirical examples of my research on structural racism and health inequities, in relation to Jim Crow and both past and present residential segregation, as measured using the Index of Concentration at the Extremes for racialized economic segregation and also historical redlining (as delineated by the 1930s federally-sponsored maps produced by the Home Owners Loan Corporation (HOLC)). Health outcomes addressed include: preterm birth; infant mortality; child mortality; cancer incidence, stage at diagnosis, and mortality; and breast cancer estrogen receptor status. The presentation concludes with reflections on embodied histories, health inequities, and the people’s health.
*Co-sponsored with the Center for the Study of Racism, Social Justice & Health