Working Papers


Job Loss, Unemployment Insurance and Health: Evidence from Brazil (Job Market Paper)
with D. Britto (Bocconi University), A. Fonseca (Federal Revenue of Brazil) and B. Sampaio (Federal University of Pernambuco)

Presentations (*scheduled): LAMES 2022*, SBE 2022*, University of Illinois

Abstract: We study the causal effects of job loss and unemployment insurance (UI) on hospitalization and mortality for Brazilian workers. We construct a novel dataset that merges millions of individual-level administrative records on employment, hospital discharges, and mortality for a period of 17 years. Using a difference-in-differences research design that compares laid-off workers from firms that experienced mass layoffs to similar workers in firms that did not, we find that job loss causes a 30% increase in the probability of male in-patient admission to public hospitals, and a 34% increase in the risk of male mortality. Our estimates are driven primarily by external causes and apply to both older and younger male workers. We find no effects on female outcomes, but children of both male and female workers are subjected to higher risks of hospitalization following their parent's job dismissal. Using a regression-discontinuity design that exploits variation in UI eligibility following job loss, we find that UI largely offsets the risk of hospitalization for older male workers. Our results indicate that governmental labor market policies can effectively mitigate a substantial portion of the adverse health impacts of job loss.


Monitoring Transfers to Public Health: Evidence from Randomized Audits in Brazil

Presentations: LACEA 2021, MEA 2021, SBE 2020, University of Illinois

Abstract: This paper presents evidence that the exogenous release of information on mismanagement of federal resources to public healthcare in Brazil led to lower funding to this sector in following years. I leverage from an inspection policy based on randomized audits to the public accounts of Brazilian municipalities, which was implemented nationwide by a federal agency. Using data from reports generated from these audits, combined with administrative data on federal transfers to health and healthcare programs, I show empirical, reduced-form estimates that transfers are significantly reduced to municipalities where a higher incidence of irregularities was revealed through the audits. Preferred estimates suggest that procured transfers to infrastructure maintenance in public healthcare establishments (which are made through contractual agreements with local vendors or governments called "partnerships") in those municipalities are reduced in at least 58%, on average. Back-of-the-envelope calculations indicate such figure should correspond to total cuts of about 5.57 billion Reais (roughly 1.4 billion US Dollars). These reductions, however sizable, do not appear to impact provision at the endpoints of such transfers, as additional estimations show that audits are inconsequential to observable measures of public healthcare infrastructure. Both results combined suggest that, at the observable extensive margin, supervision through random audits may help improve efficiency in public healthcare spending.


Lights Out: Short-Term Sleep Deprivation and Diabetes
with L. Emanuel (Federal University of Bahia), B. Sampaio (Federal University of Pernambuco) and W. Toro (Mato Grosso State University)

Presentations: SBE 2016

Abstract: We exploit the quasi-experiment induced by Daylight Saving Time (DST) to assess the impact of short-term sleep deprivation as a risk factor for diabetes mellitus using data from Brazil. Applying non-parametric regression discontinuity techniques, we provide credible evidence that transition to DST causes hospital admissions for diabetes to increase in around 6% to 8% in states that adopt DST policy. Decomposition by age and gender shows that this effect is mostly evident in the male population above sixty years of age. Additionally, health care expenses for diabetes treatment and mortality also respond to the policy and increase by around 18.9% and 8.5%, respectively. None of these changes are observed in states that do not adopt DST policy. Moreover, using untreated states as control for those that adopt the policy in a difference-in-differences framework, we find that the effect persists for the first 4 days of DST. Back-of-the-envelop calculations imply DST increases health care expenses by around $1.7 million, and cause a total of 89 deaths at a social cost of $.356-.89 billion over the 5 year sample period we analyze.


Selected Work in Progress


The Economic Impacts of Children's Health Shocks

with D. Britto (Bocconi University), A. Fonseca (Federal Revenue of Brazil) and B. Sampaio (Federal University of Pernambuco)

Presentations: Bocconi University, University of Illinois

Abstract (Preliminary): In this project, we study the economic impacts of children's health shocks on families. We use a novel dataset on Brazilian families constructed from millions of links between parents and children, spanning several decades and covering a wide range of socioeconomic backgrounds. Combining it with administrative data on formal employment and health, and employing an event study approach that explores variation in the timing of children's in-patient admissions to public hospitals, we find that children's health shocks have persistent, positive impacts on parents' labor supply and earnings. Early estimates show that the average probability of employment up to four years after the shock increase in 4% and 8% for male and female parents, respectively, with labor earnings increasing respectively by 9% and 12%. We further document that children's hospitalization cause an increase in enrollment of private health insurance plans (for parents and children), and a decrease in children's out-patient visits to public primary care centers. These results, prevalent among high-income families, suggest that effects may to some extent be driven by parents seeking to provide better health care to their children. Planned extensions to this project include investigating (i) the mediating effect of a federal policy permitting parental work leave to accompany children in hospital visits; (ii) spillover health impacts on parents and siblings (especially mental health and/or risky behavior); (iii) migration of families to places with better jobs or health care; (iv) impacts on children's educational attainment (and of their siblings); and (v) litigation by parents against health providers (or the "judicialization" of health care provision).


The Impacts of Hospital Closures on Health and the Local Economy

Abstract (Preliminary): In this project I explore the local economic and health impacts of hospital closures in Brazil. Between 2005 and 2018 more than one-fifth of all hospitals in the country have closed their doors, causing severe shortages of hospital beds and sharp geographical variations in health care provision. I combine detailed geo-referenced data on hospitals (including information on total capacity and public vs. private status) and individuals living in proximity to hospitals (merged with their records of in-patient public hospital admissions, enrollment in private health insurance, and mortality). My empirical analysis is based on a two-step approach. First, I use discrete choice models to understand how the demand for health care is affected by various individual-level characteristics, using hospital closures as a source of variation in health care supply. Second, I use a difference-in-differences analysis that exploits the variation in the timing of hospital closures to estimate their impacts on several individual health outcomes, using estimates in the first part as a guide to perform heterogeneity exercises. Planned extensions to this project include investigating (i) impacts on local migration by individuals more likely to depend on health care services, such as the poor and the elderly; and (ii) impacts on local labor markets, specially in sectors and services related with (or affected by) the health care sector.


Peer-Reviewed Publication


Broadband Internet and Protests: Evidence from the Occupy Movement (Pre-Doctoral Work)
Information Economics and Policy, 2022, 60, 100982; pub. link.
with R. Lima (Federal University of Pernambuco) and B. Sampaio (Federal University of Pernambuco)

Presentations: AEA/ASSA 2017, APET 2016, SBE 2015, University of Brasilia

Abstract: This paper investigates the influence of broadband Internet availability in the occurrence of events of civil unrest. Using collected data on 2011's Occupy Movement in the U.S., we find that each new Internet Service Provider (which is associated to an increase in broadband penetration) accounts for an increase between 1 and 3 p.p. in the probability of observing protests in a given location. Results are consistent when analyzing county-level data for the contiguous U.S., for each different U.S. region separately (Northeast, Midwest, South and West), and when analyzing city-level data for California.