American Delusion: Life Expectancy and Welfare in the US from an International Perspective (with Rodrigo R. Soares and Rudi Rocha). Journal of Human Capital (2022).

Recent increases in mortality have brought life expectancy back to the forefront of the public health debate in the US. Though unprecedented, this trend comes after an equally striking phenomenon: a decades long deterioration in the relative position of the US in the world’s life expectancy distribution, culminating in the late 2010s in a gap of close to 3 years to the OECD average. This paper takes a comparative approach and documents the relative performance of life expectancy in the US from an international perspective. We characterize the changes in this relative performance over time, its age and cause of death profiles, and estimate its welfare implications. We show that this phenomenon is not recent, is not restricted to very particular causes of death, but is mostly driven by adult and old age mortality. We calculate that welfare gains in the US over the last few decades could have been between 19% and 28% higher had the US been able to reproduce the average health performance of OECD countries at their typical health expenditures.

IZA Discussion Paper Series

Desigualdade em gastos municipais em saúde no Brasil e mecanismos redistributivos: uma análise longitudinal para o período 1998-2018 (with Rudi Rocha). APS em Revista, Abril 2021.

In this paper we assess trends in health expenditures and equity in health financing across Brazilian municipalities over the period 1998-2018. We document improvements in equity occurred in tandem with the introduction of the Piso da Atenção Básica (PAB) and the 29th Constitutional Amendment of 2000. Yet, the reduction in inequality faded by the beginning of the 2010s. Moreover, we observe that inequalities persist among municipalities with high and low fiscal capacity. We also document that the reduction in inequality fades despite the equalizing efforts of the PNAB reform that redefined the PAB fixo. Redistribution of resources introduced via PAB fixo was not sufficiently effective for relevant changes in equity.

Working Papers

Does Increasing Public Spending in Health Improve Health? Lessons from a Constitutional Reform in Brazil (with Rudi Rocha and Damian Clarke) [paper]

We examine the link between public spending in health and health outcomes by leveraging differential exposure to a health spending reform prompted by Brazil’s 29th Constitutional Amendment, which mandated municipalities to spend at least 15% of their budget on health. We map dynamic effects on health care spending, inputs, access, outputs and outcomes. For municipalities initially spending below the 15% threshold, we find (a) large increases in health spending specifically, driven by administrative spending, infrastructure investment, and human resources; (b) a resulting greater supply of personnel, primary care coverage, and municipal hospitals; and (c) reductions in infant mortality rates, in particular for deaths during the neonatal period. While we find substantial cost increases and lower mortality elasticities compared with previous correlational parameters, benefits still exceed costs provided any VSL greater than US$764 thousand. Our results contribute to the literature by providing one of the first well-identified causal parameters of the relationship between public spending in health and health outcomes, by documenting the links in the chain connecting government health expenditure to health outcomes, and by considering spillovers across space and sectors.

Won the Prize of Best Applied Microeconomics Article of the 44th Meeting of the Brazilian Econometric Society

Work in Progress

Opportunistic Public Health Spending and Electoral Returns: Evidence from Brazil

This paper describes the relationship between term limits and opportunistic political business cycles in public health care, and to document the electoral returns of public health spending at the local level. By leveraging the variation in health spending promoted by Brazil’s 29th Constitutional Amendment of 2000 we are able to describe differential increases in spending, types of spending and health inputs, between municipalities with mayors in first and second mandates. Moreover, we take advantage of this exogenous variation to estimate the electoral returns to health spending. Our results suggest that term limits lead to opportunistic behavior and that voters reward increases in health spending. The estimates suggest that this effect is mediated by increases in primary care coverage and the supply of hospitals.

Health Transition and Inequality of Life Expectancy in Brazil: The Role of Aging and External Causes

This paper documents trends in life expectancy inequality across Brazilian states. We apply demographic methods to estimate the main determinants of the slowdown of the convergence process. Our analysis suggests that young adult and mid-aged mortality and mortality due to external causes are the main drivers of that process, with elderly mortality gaining importance in the last years.

Policy Briefs

These policy briefs were developed by the LAPP initiative for the FGV EESP CLEAR
More about LAPP

LAPP, “Laboratório de Políticas Públicas e Programas Sociais” [Public Policy and Social Programs Lab], is a platform that seeks to gather, organize and provide in a straightforward fashion, information (causal evidence) on the impacts of public policy and social programs that went under rigorous evaluation worldwide.

Other Projects

Challenges of Evaluating the Impact of Access to Online Information on Parenting: Experimental Evidence from 20,000 Mothers (with Flavio Riva)