Sven Neelsen

Effects of Prenatal and Early Life Malnutrition: Evidence from the Greek Famine

This paper examines the long run education and labor market effects from early-life exposure to the Greek 1941-1942 famine. Given the short duration of the famine, we can separately identify the famine effects for cohorts exposed in utero, during infancy and at 1 year of age. We find that adverse outcomes due to the famine are largest for infants. Further, in our regression analysis we exploit the fact that the famine was more severe in urban than in rural areas. Consistent with our prediction, we find that urban-born cohorts show larger negative impacts on educational outcomes than rural-born cohorts.

The Effect of Abortion Liberalization on Sexual Behavior: International Evidence

Most industrialized countries have increased access to abortion over the past 30 years. Economic theory predicts that abortion laws affect sexual behavior since they change the marginal cost of having risky sex. We use gonorrhea incidence as a metric of risky sexual behavior. Using a panel of 41 North American, European and Central Asian countries over the period 1980-2000, we estimate the impact of abortion law reform on risky sex. Compared to the most restrictive legislation that permits abortion only to save the pregnant woman’s life or her physical health, more liberal abortion laws are associated with at least thirty additional gonorrhea cases per 100,000 individuals. The marginal effect of laws which make abortion available on request is larger than the effect of laws which allow abortion on socioeconomic and mental health grounds. Our results are robust against a set of alternative sample constructions and model specifications.

Long-run effects of fetal influenza exposure: evidence from Switzerland.

In this paper we estimate long-run effects of fetal exposure to the 1918/19 influenza pandemic for a European country. Using data from the 1970 Swiss census, we find that the male 1919 cohort that had a strongly increased likelihood of fetal exposure to the pandemic performs significantly worse in terms of educational attainment and has a lower chance of marriage than the surrounding cohorts. Further, we find similar results when we in addition use regional differences in influenza severity to test for the impact of influenza on later-life outcomes. A set of robustness tests confirm our findings.

Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-of-Pocket Expenditures in Thailand

We estimate the impact on health care utilization and out-of-pocket (OOP) expenditures of a major reform in Thailand that extended health insurance to one-quarter of the population to achieve universal coverage while keeping health spending below 4% of GDP. Identification is through comparison of changes in outcomes of groups to whom coverage was extended with those of public sector employees and their dependents whose coverage was not affected. The reform is estimated to have reduced the probability that a sick person goes without formal treatment by 3.2 percentage points (11%). It increased the probability of receiving public ambulatory care by 2.7 ppt (5%) and of admission to a public hospital by 1 ppt (18%). OOP expenditures were reduced by one-third on average, as was the probability of spending more than 10% of the household budget on health care, while spending at the very top of the OOP distribution was reduced by one-half representing substantial reductions in exposure to medical expenditure risk. Supply-side measures implemented with the coverage extension are likely to have helped realize these effects from an increased, but still very tight, budget.

Economic Impact of Illness With Health Insurance But Without Income Insurance

We examine economic vulnerability to illness when, as for informal sector workers in Thailand, there is universal coverage for health care but earnings losses are uninsured. Even with comprehensive health care entitlement, severe illness that strikes an initially healthy worker is found to raise out-of-pocket medical expenses by around two thirds and increase the probability that medical spending absorbs more than a tenth of the household budget by nine percentage points. Moreover, severe illness reduces the probability of remaining in employment by 18 points and precipitates a reduction in household labor income of almost one third. Despite the rise in medical expenses and fall in earnings, households are able to maintain expenditure on goods and services other than medical care by drawing on remittances and informal transfers, cutting back on saving, and by borrowing. In the short term, informal insurance fills gaps left uncovered by formal insurance but there is likely to be subst antial exposure to economic risks associated with long-term illness.

Progressive Universalism? The Impact of Targeted Coverage on Healthcare Access and Expenditures in Peru

Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to healthcare by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population’s change in healthcare utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal healthcare when sick is increased by almost two fifths, while the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow cover offered, there is no impact on use of inpatient care. Mean out-of-pocket (OOP) expenditure on healthcare is unaffected but spending is reduced by up to one quarter at some points of the distribution. Among healthcare users, medical spending is reduced across much of the distribution and in relative terms falls most at lower quantiles, which is consistent with limited nominal and effective coverage of expensive treatments.

The Greek Famine of 1941–1942 and Its Impact

The Greek Famine of 1941-1942 provides a natural experiment to test the fetal origins hypothesis. This hypothesis states that exposure to detrimental conditions during the fetal stage leads to worse health and socioeconomic outcomes in adulthood. This chapter first describes the Greek famines causes. It then reviews the impact of the Greek famine on the education and labor market outcomes of the individuals exposed to the famine in utero or in early childhood. Corroborating Barkers hypothesis, the evidence indicates that the Greek famine significantly reduced educational attainment for those who experienced it before their third year of life. The famine also reduced labor market success for those with famine exposure in their early childhood. This finding is partly driven by a shift towards rural birthplaces in the famine years. The sum of the findings underscores the importance of averting early childhood malnourishment.

Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru: Impacts of targeted health coverage in Peru

Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to health care by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target populations change in health care utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal health care when sick is increased by almost two fifths, but the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow coverage offered, there is no impact on use of inpatient care. Neither is there any effect on average out-of-pocket health care expenditure, but medical spending is reduced by up to 25% in the top quarter of the distribution. Copyright

Early-Life Famine Exposure and Later-Life Outcomes: Evidence from Survivors of the Greek Famine

This chapter examines education and labor market outcomes for cohorts with early-life exposure to the Greek 1941-42 famine. Given the short duration of the famine, we can separately identify effects for cohorts exposed as fetuses, infants and one-year-olds. Our empirical analysis uses data from the 1971, 1981, 1991, and 2001 Greek National Population Housing Censuses. For our main specification that includes birthplace controls, we find negative cohort effects on the likelihood of completing upper secondary school for the cohorts exposed as infants and one-year- olds.Because the famine was more severe in urban areas, we also estimate separate models for urban and rural-born individuals. Consistent with our prediction, the negative cohort effects for the early-life famine exposed cohorts are larger in the urban-born subsample.The negative cohort effects increase in specifications without birthplace controls. We attribute a part of this increase to a rising share of individuals from areas with negative education and labor market prospects in the cohorts with early-life famine exposure. The cohort effect difference between specifications with and without birthplace controls is largest for the 1942 cohort, a large part of which was conceived during the famine. We suggest that this finding is due to the fact that negative birthplace selection into this cohort occurred not only through famine mortality, like in the other cohorts with early-life exposure, but also through famine-related falls in fertility.