Essays on Health and Public Policy
This dissertation is composed of two essays focusing on some key emerging issues of health economics in developing countries. In the first chapter, I examine the role of the largest public works program in the world- the National Rural Employment Guarantee Scheme (NREGS) - in buffering the negative effects of early childhood exposure to rainfall shocks on long-term health outcomes. Collecting very detailed administrative records of rainfall shocks and policy coverage, I integrate it with a rich household level panel data from the Young Lives Survey, that follows children from year 2002 to 2010. Using three waves of the panel data spanning over eight years, the study employs individual-fixed effects estimation to analyze the extent of catch-up in height for age for the rural sample exploiting the phase wise variation in roll out of the policy across households. We find while the program does not help correct long term past health deficiencies, it is useful in buffering recent drought shocks. Interestingly, we find the extent of this mitigation varies by policy relevant subgroups, where we find it benefits significantly the poor households from lower caste and lower educational background. We find early drought exposure decreases the height for age score by .4 standard deviations and increases average stunting rate by 8%. For individuals exposed to drought, we find an increase in one standard deviation in average program days increases height-for-age by around .26 standard deviations, which is about half the rural-urban gap in terms of magnitude. The findings indicate while there is long-run impact of early-life conditions on health several years later, access to the program helps to partially mitigate recent shocks but not correct for longer-term past deficiencies. Since there is little scope of remediation in correcting past deficiencies, the study highlights the key role that a social protection policy can play in safe-guarding households against such negative shocks.
The second chapter examines the extent of reporting biases in self-reported health response across demographic sub-groups using the unique nationally representative data collected by the World Health Survey-SAGE survey from India, that has self-reported assessments of health linked to anchoring vignettes as well as objective measures like body mass index and performance tests on a range of different domains of health. Analysis of the vignettes responses reveals a systematic under-reporting of worse health among the individuals from less developed states in India, which is statistically significant across various health domains. While males and urban residents were found to systematically under-report ill-health, individuals over 60 years were found to over-report ill health. Utilizing a battery of objective health measures, we introduce a methodology to implicitly test the assumption of `response consistency' in vignettes and confirm its validity by identifying similar systematic bias in self-reported health responses across covariates. Further examination of reporting bias by exploiting the individual fixed effects reveals that substantial variation in self-reported health remains unexplained even after controlling for the usual covariates. The results seem to suggest that systematic differences in self-reported health response, even within a country, needs to be accounted for while making inter group comparisons valid and lends support to the use of the vignette technique for identifying this bias.