SUBMITTED WORK AND WORKING PAPERS

"Errors in Reporting and Imputation of Government Benefits and Their Implications" (with N. Mittag and B. Meyer). [NBER w29184].

We document the extent, nature, and consequences of survey errors for receipt of cash welfare and SNAP in three major U.S. household surveys linked to administrative program records. Our results confirm earlier evidence of frequent misreporting of program receipt, particularly failure to report receipt. The surveys poorly capture patterns of participation in multiple programs, even though there is not much evidence of program confusion. Error rates are higher among imputed observations, which also account for a large share of false positive errors. Many household characteristics have significant effects on errors in reporting receipt, both false positives and false negatives. Among others, we find large differences in survey error by race, ethnicity, and income. We provide evidence on the consequences of these errors for models of program receipt. Estimated effects of, among others, income and race are biased downward. On the positive side, our results confirm a tendency to attenuation in models with misclassified dependent variables that preserves many qualitative results in the survey estimates. We then examine error due to item non-response and imputation, as well as whether imputation improves estimates. Item non-respondents have higher receipt rates than the population, even conditional on many covariates. The joint distribution ofs program receipt and these covariates differs between item non-respondents and the entire population, but also between accurate and imputed receipt among item non-respondents. Thus, neither excluding item non-respondents nor using their imputed values yields consistent estimates. For binary choice models of program receipt, estimates from the linked data favor excluding item non-respondents over using their imputed values. The biases in each case are well predicted by the error patterns we document, so such analyses can help researchers make more informed decisions on the use of imputed values.

"Stigma in Welfare Programs," (with N. Mittag and B. Meyer). [Link][NBER  w30307]. R&R Review of Economics and Statistics.

Stigma of welfare participation is important for policy and survey design, because it deters program take-up and increases misreporting. Stigma is also relevant to the literature on social image concerns, yet empirical evidence is scant because stigma is difficult to empirically identify. We use a novel approach to studying stigma by examining the relationship between program participation in a recipient’s local network and underreporting participation in surveys. We find a robust negative relationship and rule out explanations other than stigma. Stigma decreases when more peers engage in the stigmatized behavior and when such actions are less observable. 

"Educational Mobility Across Three Generations in Latin American Countries,"  (with S. Gallegos). [Link]. R&R Journal of Population Economics.

This paper presents new evidence on educational mobility across three generations in six Latin American countries (LAC). Combining survey information with national census data we build a data set with 50,000 triads of grandparents-parent-children born between 1890 and 1990. We estimate a five mobility measures, to show that (i) the empirical multi-generational persistence is high in LAC; (ii) it is much larger than what Becker & Tomes (1986) theoretical model predicts, with a bias that is twice as large for LAC compared to developed countries; (iii) Clark’s theory (2014) of high and sticky persistence provides a better approximation for describing mobility across multiple generations in developing countries. We also uncover that while relative measures suggest stagnant mobility across generations, there are significant improvements according to non-linear measures suggested by Asher, Novosad & Rafkin (2022). This result is especially relevant for developing countries such as LAC, where historical educational expansions have especially benefited the lower end of the schooling distribution.

"An ounce of prevention for a pound of cure: Basic health care and efficiency in health systems"  (with A. Bancalari, P. Bernal, S. Martinez and MD. Sanchez). Submitted. [Link].  

We examine the efficiency gains in health systems generated after the national roll out of basic healthcare in El Salvador between 2010 and 2013. Using data from over 120 million consultations and five million hospitalizations, we demonstrate that the expansion of community health teams, comprising less-specialized health workers, increases preventive care and decreases curative care and preventable hospitalizations. We also estimate coverage improvements for previously unattended chronic conditions amenable to effective primary care. These results suggest that decentralization of tasks to less-specialized health workers improves efficiency, maintaining quality of care.

"Encouraging preventative care to manage chronic disease at scale,"  (with C. Boone, P. Gertler, and T. Gracner). [NBER w31643] 

We study how reminding high-risk patients with chronic disease of their upcoming primary care appointments impacts their health care and behaviors. We exploit a natural experiment in Chile’s public healthcare system that sent reminders for preventative care appointments to over 300,000 patients with type 2 diabetes and hypertension. Employing a difference-in-difference approach on national administrative patient-level data, we show that reminders increased preventative care visits, which led to more health screenings and improved medication adherence. In this at-scale program, we find substantial variation in implementation fidelity across clinics, which, once accounted for increases our estimates by over a third. We also find increased hospitalizations and a reduction in-hospital mortality, suggesting an improvement in timely care-seeking behavior among high-risk patients. Our findings inform settings with a gate-keeper healthcare model where patients must first visit their primary care provider before being approved for tests, prescribed medication, or referred out. Through intervening at the first step in the cascade of care, we find that even a simple intervention such as reminders can have large and meaningful downstream effects.

"How managers can use purchaser performance information to improve procurement efficiency,"  (with P. Gertler, M. Olivares and R. Undurraga). [NBER w32141]. Submitted.

We examine the effect of performance monitoring in public procurement through the lens of organizational culture in a principal-agent model where the manager (principal) and buyers (agents) may have different beliefs about how much the government values efficiency. We show that the effect of performance information not only increases efficiency but is greater when the buyer’s belief is stronger than the manager’s belief. We leverage a new e-procurement system in Chile to test these ideas by randomizing monthly reports on the purchasing performance of buyers and further whether the individual performance reports were disclosed to managers. We find that the reports generated sizable reductions in overspending — with savings reaching a 15% reduction or 0.1% of GDP — but only when individual performance was observable to managers. This is consistent with extrinsic motivation rather than intrinsic motivation driving buyer behavior. Consistent with the theoretical model, we also find that the gain in efficiency is concentrated in procurement units where buyer belief that the government cares about efficiency is stronger than manager belief. Our results highlight the key role played by organizational culture in mediating the impact of purchasing performance information on preventing the misuse of public resources.

"Fostering Thriving from Survival: Short Term Effects of Cash Assistance for Refugees,"  (with S. Martinez, C. Huang, C. Alviar and A. Stamatiadi). 

Political and economic turmoil in Venezuela led to the largest-ever refugee crisis in Latin America. We study the short-run effects of emergency multipurpose cash transfers to vulnerable migrants in urban and peri-urban areas of Colombia. Using administrative and survey data on a sample of 3,190 migrants, we implement a sharp regression discontinuity strategy based on the program’s eligibility rules. One to three months after exiting the program, treated households increase hours worked, income and expenditures, and experience large reductions in perceptions of discrimination and insecurity, and report higher life satisfaction. These positive effects are attributed, at least in part, to a decrease in food insecurity and a reduction in reliance on coping strategies.