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
Desigualdade em gastos municipais em saúde no Brasil e mecanismos
redistributivos: uma análise longitudinal para o período 1998-2018 (with
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.
This paper assesses the causal effects of public
health spending on health outcomes by leveraging the variation in health
spending prompted by Brazil’s 29th Constitutional Amendment of 2000. We
are also able to document the links in the chain connecting spending
reform to health outcomes. We show that (a) a constitutional amendment
mandating minimum health spending effectively changes spending patterns
both for municipalities which were previously below spending floors as
well as those that were above spending floors; (b) these increases in
health spending translate into greater primary care coverage, higher
supply of hospitals and less-skilled professionals,and; (c) that
spending increases lead to moderate reductions in infant mortality
within 24 hours and due to perinatal conditions, as well as long term
reductions in total infant mortality and infant mortality amenable to
primary care, among other causes. Our results contribute to the
literature on the impacts of health spending by providing one of the
first well-identified causal parameters of the relationship between
public health spending and health outcomes.
Won the Prize of Best Applied Microeconomics Article of the 44th Meeting of the Brazilian Econometric Society
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.
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.
Challenges of Evaluating the Impact of Access to Online Information on Parenting: Experimental Evidence from 20,000 Mothers (with Flavio Riva)