Larry L. Howard

DO SCHOOL LUNCH SUBSIDIES CHANGE THE DIETARY PATTERNS OF CHILDREN FROM LOW-INCOME HOUSEHOLDS?

This article examines the effects of school lunch subsidies provided through the meanstested component of the National School Lunch Program on the dietary patterns of children age 10- to 13 yr in the USA. Analyzing data on 5,140 public school children in 5th grade during spring 2004, we find significant increases in the number of servings of fruit, green salad, carrots, other vegetables, and 100 percent fruit juice consumed in one week for subsidized children relative to unsubsidized children. The effects on fruit and other vegetable consumption are stronger among the children receiving a full subsidy, as opposed to only a partial subsidy, and indicate the size of the subsidy is an important policy lever underlying the programs effectiveness. Overall, the findings provide the strongest empirical evidence to date that the means-tested school lunch subsidies increase childrens consumption over a time period longer than one school day.

Do Employment Quotas Explain the Occupational Choices of Disadvantaged Minorities in India

This article investigates the effects of a large-scale public sector employment quota policy for disadvantaged minorities (Scheduled Castes and Scheduled Tribes) in India on their occupational choices, as defined by skill level, during the 1980s and 1990s. We find that, first, the employment quota policy significantly affects the occupational structure of both disadvantaged minority populations. In response to the employment quotas, individuals belonging to the Scheduled Caste group are more likely to choose high-skill occupations and less likely to choose low- and middle-skill occupations, while individuals belonging to the Scheduled Tribe group are less likely to choose high-skill occupations and more likely to choose low- and middle-skill occupations. Second, the impact of the employment quotas is significantly related with an individuals years of schooling. Overall, the results indicate that the employment quota policy changes the occupational choices of individuals within the targeted populations and contributes to their improved socio-economic standing.

Modeling The Effects Of Immunizations Timing On Child Health Outcomes In India

Timely vaccinations of children in developing countries are important for reducing morbidity and mortality, which are Millennium Development Goals. However, a majority of children do not possess vaccination cards compiling information on timing. We investigated the benefits of vaccination cards for the uptake of immunizations against diphtheria, pertussis and tetanus (DPT), polio, tuberculosis (BCG), and measles using data on over 200,000 Indian children from the District Level Health and Facility Survey 3. Methodological issues such as whether parents of children with higher morbidity levels may have them vaccinated were investigated. The results from the models for DPT, polio, measles, and BCG vaccinations showed significant beneficial effects of maternal education, household possessions, and access to health care facilities. Moreover, models for childrens ages at the time of vaccination showed significant interactions between maternal education and access to and availability of health care facilities. Finally, models for child morbidity due to diarrhea, cough, and fever showed that timely vaccinations against DPT, access to piped water, and cooking with electricity or natural gas were associated with lower morbidity. Overall, issuing paper or electronic vaccination cards to children is likely to enhance timely uptake of various immunizations thereby reducing child morbidity.

Food Insecurity Experiences Predict Children’s Fruit and Vegetable Consumption in the USA

This research analyses the longitudinal relationships between household food insecurity (very low and low food security) experiences and childrens consumption (servings/week) of fruit, green salad, carrots, potatoes, and other types of vegetables. Using a panel of 5,670 children aged 10–13 years who were first observed in spring 2004 and then again in spring 2007 at age 13–16 years, the main findings are as follows: first, children experiencing low food security consume significantly (P < 0.05) more fruit per week. In contrast, children experiencing very low food security consume significantly more carrots and potatoes per week, and estimates based on gender-stratified models indicate that the association is strongest among girls. Second, activity patterns are significantly related to childrens dietary patterns; physical exercise is positively associated with fruit, green salad, carrot, and other vegetables consumption, while television watching is positively associated with potato consumption. Overall, the findings suggest that children living in food insecure home environments consume a greater number of servings of fruits and vegetables per week, relative to children living in food secure home environments.

Is the Demand for Health Care Generosity Equal for All Recipients? A Longitudinal Analysis of State Medicaid Spending, 1977-2004

This article estimates an economic model of the determinants of state government spending on health care benefits provided through the Medicaid program for the old, disabled, and young populations, respectively. Spending on the mutually exclusive recipient groups, rather than the aggregate, is examined to ascertain the extent to which one population’s costs supplant spending on the alternative populations. Endogeneity bias arising from the incentive effects of health care benefit guarantees on program take-up is addressed using an identification strategy that relies on measures of time-varying state resident participation in federally administered welfare programs to control for unobservable economic and noneconomic opportunities simultaneously determining Medicaid recipiency. It finds that state demand for health care generosity for each population is interrelated with the specific costs of the alternative populations. Simulations of eligibility expansions targeting each of the recipient populations illustrate the substitution effects evident in state Medicaid spending.

Remittances channels and the physical growth of Honduran children

Abstract Ensuring the availability of food and other resources for young children is important for sustaining physical growth. We examine the role of remittances and its associated implications in determining heights and weights of 4459 children aged 0–5 years in Honduras in 2004. To address the endogeneity problem with household remittance receipt, we take advantage of the timing of Hurricane Mitch in 1998 to construct instrumental variables that are exogenously related to migration decisions made before children included in the later survey were conceived. We find that children are significantly taller and heavier for their age and gender in households receiving remittances. Further investigation of household spending indicates significant changes in food purchases and dietary diversity. Households receiving remittances are more likely to include fish, fruits, and meats in their diets. Additional findings also indicate that households receiving remittances spend absolutely more on food, health care, education, and durable goods. Overall, the findings provide strong evidence that remittances change household consumption and increase children’s body sizes.

Do the Medicaid and Medicare programs compete for access to health care services? A longitudinal analysis of physician fees, 1998–2004

As the demand for publicly funded health care continues to rise in the U.S., there is increasing pressure on state governments to ensure patient access through adjustments in provider compensation policies. This paper longitudinally examines the fees that states paid physicians for services covered by the Medicaid program over the period 1998–2004. Controlling for an extensive set of economic and health care industry characteristics, the elasticity of states’ Medicaid fees, with respect to Medicare fees, is estimated to be in the range of 0.2–0.7 depending on the type of physician service examined. The findings indicate a significant degree of price competition between the Medicaid and Medicare programs for physician services that is more pronounced for cardiology and critical care, but not hospital care. The results also suggest several policy levers that work to either increase patient access or reduce total program costs through changes in fees.

Does Government Oversight Improve Access to Nursing Home Care? Longitudinal Evidence From US Counties

Gains in life expectancy around the world have increasingly placed pressure on governments to ensure that the elderly receive assistance with activities of daily living. This research examines the impact of government oversight of Medicaid payment policies on access to nursing home care services in the United States. Variation in price levels induced by a federal policy shift in 1997 is used to identify the effect of Medicaid reimbursements on the number of nursing homes and beds available. Court rulings prior to the policy change are used to categorically define a range of oversight treatments at the state level. Difference-in-differences estimates indicate a significant decline in access to nursing home care services for individuals living in states in which courts consistently ruled that Medicaid reimbursements did not meet the minimum standard implied by federal law. The findings suggest that nursing home care services were made more accessible through a combination of legislative and judicial oversight of Medicaid payment policies.