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Does social health insurance spillover to student performance? Evidence from an RDD in Peru

Author

Listed:
  • Miguel Ángel Carpio

    (Universidad de Piura)

  • Lucero Gómez

    (Universidad del Pacífico)

  • Pablo Lavado

    (Universidad del Pacífico)

Abstract

The literature on the effects of Social Health Insurance focuses on its stated goals, namely health status and financial protection; but little work exists on its effect on education. In this paper, we examine the effect of the Peruvian program on student performance by means of a sharp regression discontinuity design. We use a unique individual-level database built from the merger of detailed data from a household survey and standardized test scores from a national census. We find large effects of health insurance on mathematics and reading scores. Moreover, we analyze the main potential mechanisms: health of child, health of family members, and status of household finances. The clearest channel is a lower incidence of anemia among children and mothers, probably due to better nutrition. Finally, we explore whether the effect of health insurance on test scores is heterogeneous by sex to the extent that the data allow. We find it is mostly driven by girls who are better off across the entire score distribution.

Suggested Citation

  • Miguel Ángel Carpio & Lucero Gómez & Pablo Lavado, 2021. "Does social health insurance spillover to student performance? Evidence from an RDD in Peru," Working Papers 178, Peruvian Economic Association.
    • Handle: RePEc:apc:wpaper:178
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    References listed on IDEAS

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    1. repec:plo:pone00:0225237 is not listed on IDEAS
    2. Gabriella Conti & Rita Ginja, 2023. "Who Benefits from Free Health Insurance?: Evidence from Mexico," Journal of Human Resources, University of Wisconsin Press, vol. 58(1), pages 146-182.
    3. Abhijit V. Banerjee & Esther Duflo, 2007. "The Economic Lives of the Poor," Journal of Economic Perspectives, American Economic Association, vol. 21(1), pages 141-168, Winter.
    4. Chen, Yuyu & Jin, Ginger Zhe, 2012. "Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China," Journal of Health Economics, Elsevier, vol. 31(1), pages 1-14.
    5. Adam Wagstaff, 2010. "Estimating health insurance impacts under unobserved heterogeneity: the case of Vietnam's health care fund for the poor," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 189-208, February.
    6. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, vol. 154(C), pages 122-136.
    7. Cesur, Resul & Güneş, Pınar Mine & Tekin, Erdal & Ulker, Aydogan, 2017. "The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey," Journal of Public Economics, Elsevier, vol. 150(C), pages 75-93.
    8. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust data-driven inference in the regression-discontinuity design," Stata Journal, StataCorp LLC, vol. 14(4), pages 909-946, December.
    9. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    10. Glewwe, Paul & Jacoby, Hanan G. & King, Elizabeth M., 2001. "Early childhood nutrition and academic achievement: a longitudinal analysis," Journal of Public Economics, Elsevier, vol. 81(3), pages 345-368, September.
    11. Conti, Gabriella & Ginja, Rita, 2016. "Health Insurance and Child Health: Evidence from Mexico," IZA Discussion Papers 10122, Institute of Labor Economics (IZA).
    12. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust Nonparametric Confidence Intervals for Regression‐Discontinuity Designs," Econometrica, Econometric Society, vol. 82, pages 2295-2326, November.
    13. Carlo Alcaraz & Daniel Chiquiar & María José Orraca & Alejandrina Salcedoa, 2017. "The Effect of Publicly Provided Health Insurance on Education Outcomes in Mexico," The World Bank Economic Review, World Bank, vol. 30(Supplemen), pages 145-156.
    14. Sarah Baird & Joan Hamory Hicks & Michael Kremer & Edward Miguel, 2016. "Worms at Work: Long-run Impacts of a Child Health Investment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1637-1680.
    15. Arnab Acharya & Sukumar Vellakkal & Fiona Taylor & Edoardo Masset & Ambika Satija & Margaret Burke & Shah Ebrahim, 2013. "The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review," The World Bank Research Observer, World Bank, vol. 28(2), pages 236-266, August.
    16. Sebastian Calonico & Matias D. Cattaneo & Max H. Farrell & Roc ́ıo Titiunik, 2017. "rdrobust: Software for regression-discontinuity designs," Stata Journal, StataCorp LLC, vol. 17(2), pages 372-404, June.
    17. Sven Neelsen & Owen O'Donnell, 2017. "Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 179-203, December.
    18. Alberto Chong & Isabelle Cohen & Erica Field & Eduardo Nakasone & Maximo Torero, 2016. "Iron Deficiency and Schooling Attainment in Peru," American Economic Journal: Applied Economics, American Economic Association, vol. 8(4), pages 222-255, October.
    19. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    20. Raj Chetty & John N. Friedman & Nathaniel Hilger & Emmanuel Saez & Diane Whitmore Schanzenbach & Danny Yagan, 2011. "How Does Your Kindergarten Classroom Affect Your Earnings? Evidence from Project Star," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(4), pages 1593-1660.
    21. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
    22. Harold Alderman & Jere R. Behrman & Victor Lavy & Rekha Menon, 2001. "Child Health and School Enrollment: A Longitudinal Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 36(1), pages 185-205.
    23. Frandsen, Brigham R. & Frölich, Markus & Melly, Blaise, 2012. "Quantile treatment effects in the regression discontinuity design," Journal of Econometrics, Elsevier, vol. 168(2), pages 382-395.
    24. Sebastian Bauhoff & Roxanne Oroxom, 2019. "The Effects of an ID Requirement for Health Insurance on Infants' Health Care Utilization and Health Outcomes: Evidence from Peru's Seguro Integral de Salud," Working Papers 514, Center for Global Development.
    25. Phillip B. Levine & Diane Schanzenbach, 2009. "The Impact of Children's Public Health Insurance Expansions on Educational Outcomes," NBER Chapters, in: Frontiers in Health Policy Research, volume 12, National Bureau of Economic Research, Inc.
    26. Paul Gertler & David I. Levine & Minnie Ames, 2004. "Schooling and Parental Death," The Review of Economics and Statistics, MIT Press, vol. 86(1), pages 211-225, February.
    27. Gustavo J. Bobonis & Edward Miguel & Charu Puri-Sharma, 2006. "Anemia and School Participation," Journal of Human Resources, University of Wisconsin Press, vol. 41(4).
    28. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
    29. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, January.
    30. Grant Miller & Diana Pinto & Marcos Vera-Hernández, 2013. "Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor," American Economic Journal: Applied Economics, American Economic Association, vol. 5(4), pages 61-91, October.
    31. Matias D. Cattaneo & Michael Jansson & Xinwei Ma, 2018. "Manipulation testing based on density discontinuity," Stata Journal, StataCorp LLC, vol. 18(1), pages 234-261, March.
    32. Diether Beuermann & Camilo Pecha, 2016. "Healthy to Work: The Impact of Free Public Healthcare on Health Status and Labor Supply in Jamaica," IDB Publications (Working Papers) 96656, Inter-American Development Bank.
    33. Huang, Wei & Liu, Hong, 2023. "Early childhood exposure to health insurance and adolescent outcomes: Evidence from rural China," Journal of Development Economics, Elsevier, vol. 160(C).
    34. Imbens, Guido W. & Lemieux, Thomas, 2008. "Regression discontinuity designs: A guide to practice," Journal of Econometrics, Elsevier, vol. 142(2), pages 615-635, February.
    35. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    36. Limwattananon, Supon & Neelsen, Sven & O'Donnell, Owen & Prakongsai, Phusit & Tangcharoensathien, Viroj & van Doorslaer, Eddy & Vongmongkol, Vuthiphan, 2015. "Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand," Journal of Public Economics, Elsevier, vol. 121(C), pages 79-94.
    37. Joan Costa & Noelia Bernal & Patricia Ritter, 2019. "El efecto del Seguro Integral de Salud en la salud Infantil: evidencia de un diseño de regresión discontinua," Investigaciones, Consorcio de Investigación Económica y Social.
    38. Sparrow, Robert & Suryahadi, Asep & Widyanti, Wenefrida, 2013. "Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme," Social Science & Medicine, Elsevier, vol. 96(C), pages 264-271.
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    2. Sebastian Calónico & Sebastian Galiani, 2025. "Beyond Bonferroni: Hierarchical Multiple Testing in Empirical Research," NBER Working Papers 34050, National Bureau of Economic Research, Inc.

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    JEL classification:

    • D04 - Microeconomics - - General - - - Microeconomic Policy: Formulation; Implementation; Evaluation
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I21 - Health, Education, and Welfare - - Education - - - Analysis of Education
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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