Essays on the economics of health and public policy in Brazil

Marques de Amorim, Guilherme

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https://hdl.handle.net/2142/121474 Copy

Description

Title

Essays on the economics of health and public policy in Brazil

Author(s)

Marques de Amorim, Guilherme

Issue Date

2023-07-13

Director of Research (if dissertation) or Advisor (if thesis)

Bernhardt, Dan

Doctoral Committee Chair(s)

Bernhardt, Dan

Committee Member(s)

• Bartik, Alex
• Marx, Ben
• Reif, Julian

Department of Study

Economics

Discipline

Economics

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Health
• Public Policy
• Labor Markets
• Brazil

Abstract

This thesis is composed of three (3) essays on the economics of health and health care in Brazil, with focus on their implications to labor markets and public policy. In the first chapter, I study the causal effects of job loss and unemployment insurance (UI) on hospitalization and mortality for Brazilian workers. I construct a novel dataset that merges millions of individual-level administrative records on employment, hospital discharges, and mortality for a period of 17 years. Using a difference-in-differences research design that compares laid-off workers from firms that experienced mass layoffs to similar workers in firms that did not, I find that job loss causes a 30% increase in the probability of male in-patient admission to public hospitals, and a 34% increase in the risk of male mortality. Estimates are driven primarily by external causes and apply to both older and younger male workers. I find no effects on female outcomes, but children of both male and female workers are subjected to higher risks of hospitalization following their parent's job dismissal. Using a regression-discontinuity design that exploits variation in UI eligibility following job loss, I show that UI largely offsets the risk of hospitalization for older male workers. Results indicate that governmental labor market policies can effectively mitigate a substantial portion of the adverse health impacts of job loss. In the second chapter, I study the economic effects of children's health shocks on families. I use a novel dataset on Brazilian families constructed from millions of links between parents and children, spanning several decades and covering a wide range of socioeconomic backgrounds. Combining it with administrative data on formal employment and health, and employing an event study approach that explores variation in the timing of children's hospitalizations and deaths, I find that children's health shocks have persistent impacts on parents' labor supply and earnings. Estimates show that the average probability of employment up to four years after an hospitalization increase in 3% and 4% for male and female parents, respectively, with labor earnings increasing respectively by 6% and 5%. I also show that children's hospitalization cause an increase in enrollment of private health insurance plans (for parents and children), and a decrease in children's out-patient visits to public primary care centers. When restricting events to severe health shocks, I find that (i) long-term hospitalizations decrease female employment, although the effect wanes after four years, and that (ii) children's deaths positively impact female parents' employment, while reducing that of male parents. Finally, in the third chapter, I present evidence that the exogenous release of information on mismanagement of federal resources to public healthcare in Brazil led to lower funding to this sector in following years. I leverage from an inspection policy based on randomized audits to the public accounts of Brazilian municipalities, which was implemented nationwide by a federal agency. Using data from reports generated from these audits, combined with administrative data on federal transfers to health and healthcare programs, I show empirical, reduced-form estimates that transfers are significantly reduced to municipalities where a higher incidence of irregularities was revealed through the audits. Preferred estimates suggest that procured transfers to infrastructure maintenance in public healthcare establishments (which are made through contractual agreements with local vendors or governments called "partnerships") in those municipalities are reduced in at least 58%, on average. Back-of-the-envelope calculations indicate such figure should correspond to total cuts of about 5.57 billion Reais (roughly 1.4 billion US Dollars). These reductions, however sizable, do not appear to impact provision at the endpoints of such transfers, as additional estimations show that audits are inconsequential to observable measures of public healthcare infrastructure. Both results combined suggest that, at the observable extensive margin, supervision through random audits may help improve efficiency in public healthcare spending.

Graduation Semester

2023-08

Type of Resource

Thesis

Copyright and License Information

Copyright 2023 Guilherme Marques de Amorim

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