09.00-09.50 Toshiaki Iizuka (University of Tokyo)
“Free for Children? Patient Cost-sharing and Health Care Utilization”
(joint with Hitoshi Shigeoka)
Understanding how patient responds to price is a key to the optimal design of health insurance. However, past studies are predominantly concentrated on the adults and elderly, and surprisingly little is known about children. We examine the effect of patient cost-sharing on health care utilization among children by exploiting newly collected data on drastic subsidy expansion in Japan, with more than 5,000 changes in subsidy status at municipality-age-time level. We find that free care for children significantly increases spending on outpatient care by 22–31%, with the arc-elasticity of –0.1 for all ages 7–14, which is smaller than the conventional estimate for adults. Interestingly, we find little evidence of asymmetric responses to the price changes of the opposite directions, implying that policy makers can reasonably employ existing elasticity estimates, regardless of the direction of the price changes. Finally, we provide suggestive evidence that that increases mostly reflect low-value or costly care. Increases in outpatient visits do not translate to reduction in hospitalization by “avoidable” conditions nor reduction in mortality. Furthermore, we document that inappropriate use of antibiotics and costly off-hour visits increase. Taken together, we conclude that the benefit of such generous subsidy is limited at least in the short-run.
10.00-10.50 Benedict Makanga (The National Graduate Institute for Policy Studies (GRIPS))
“Long-Term Effects of Armed Conflict on Trust and Behavior: Evidence
from Northern Uganda” (joint with Yoko Kijima and Chikako Yamauchi)
This paper investigates the long-term effects of exposure to armed conflict on trust, trustworthiness, and real-life pro-social behaviors by using trust measures elicited from incentivized lab-in-the-field experiments in rural northern Uganda. Overall, unlike prior studies, we do not find that trust is fostered by exposure to armed conflict either at the individual-level (whether one was abducted by a rebel group) or household-level (whether it was displaced to a camp). However, there is a heterogeneous impact among former abductees: those who were abducted when younger exhibit less trust and trustworthiness. Furthermore, those abducted seem to show higher mistrust when playing with partners in the northern region compared with other regions. In the effect on real life behavior, those abducted during conflict are more likely to engage in pro-social behaviors. To understand the seemingly contradicting findings between experimentally elicited trust and real life behavior, we investigate the mechanism, which reveals that assistance received after the conflict and the experience of holding a leadership position while with the rebels are the main channels of fostering pro-social behavior.
11.00-11.50 Yukichi Mano (Hitotsubashi University)
“Spillovers as a Driver to Reduce Ex-post Inequality Generated by
Randomized Experiments: Evidence from an Agricultural Training
Intervention” (joint with Kazushi Takahashi and Keijiro Otsuka)
Randomised experiments ensure equal opportunities but could generate unequal outcomes by treatment status, which can be socially costly. This study demonstrates a sequential intervention to conduct rigorous impact evaluation and subsequently to mitigate ‘experiment-driven’ inequality. Specifically, control farmers were initially restricted from exchanging information with treated farmers, who received rice management training, to satisfy the stable unit treatment value assumption. We then encouraged information exchange between the two groups of farmers one year after the training. We found positive training effects, but initial performance gaps created by our randomised assignment disappeared over time because of information spillovers and, hence, eventually control farmers also benefitted from our experiment.
13.00-13.50 Yuki Higuchi (Nagoya City University)
“Incentives, Self-selection, and Social Norms in the Labor Contract: A
Two-stage Field Experiment in the Philippines” (joint with Jun Goto)
This paper decomposes productivity difference between fi xed wage (FW) contract and individual piece rate (IPR) contract into self-selection and incentive effects, using unique two-stage fi eld experiment. We offered an option of switching to IPR contract for agricultural workers in the Philippines, whose default option has traditionally been FW contract, and we converted random half of those who opted for IPR contract back to the original FW contract. By comparing three groups, i.e., those who chose and worked under IPR contract, those who chose IPR but worked under FW contract, and those who chose and worked under FW contract, we find that the self-selection effect accounts for 60% of the productivity difference between the two types of contract. By combining with the data collected from lab-in-the-field experiment, we find that the choice of IPR contract is associated with social norm parameters, namely, inequity aversion and kinship tax rate. Exploiting our random group assignment, we also find that the influence of social norm is particularly strong when the workers have high probability of repeated interaction with other group members, suggesting the presence of a community enforcement mechanism in agrarian villages.
14.00-14.50 Rohini Pande (Rafik Hariri Professor of International
Political Economy at Harvard Kennedy School)
“State Capacity, State Accountability, and Poverty”