AbstractReducing socioeconomic health inequalities is a key goal of most health systems. A challenge in this regard is that healthcare providers may have incentives to avoid or undertreat patients who are relatively costly to treat. Due to the socioeconomic gradient in health, individuals with low socioeconomic status (SES) are especially likely to be negatively affected by such attempts. To counter these incentives, payments are often risk adjusted based on patient characteristics. However, empirical evidence is lacking on how, or if, risk adjustment affects care utilization. We examine if a novel risk adjustment model in primary care affected socioeconomic differences in care utilization among individuals with a chronic condition. The new risk adjustment model implied that the capitation—the monthly reimbursement paid by the health authority to care providers for each enrolled patient—increased substantially for chronically ill low‐SES patients. Yet, we do not find any robust evidence that their access to primary care improved relative to patients with high SES, and we find no effects on adverse health events (hospitalizations). These results suggest that the new risk adjustment model did not reduce existing health inequalities, indicating the need for more targeted incentives and interventions to reach low‐SES groups.

AbstractThis paper estimates the effect of Temporary Protected Status (TPS), a temporary legalization policy, on the incomes and property ownership of Salvadoran recipients over 20 years. We compare likely undocumented Salvadoran immigrants eligible for TPS to a control group of likely undocumented immigrants ineligible for TPS in an event study design that allows us to observe the policy's effects over 2 decades. We find that earnings, homeownership, and use of a car increased considerably for at least 15 years following the granting of TPS. This suggests that even temporary and limited legal status can have substantial and sustained benefits for recipients.

AbstractWe examine how physicians’ practice locations are affected by Medicaid expansions. We focus on the dramatic Medicaid eligibility expansions for pregnant women that took place between the early 1980s and the early 1990s. Following a recently‐developed estimation strategy, we identify the change in OB/GYN supply due to the expansions in an event‐study framework. We find that OB/GYN counts per capita grew post‐expansion and the increase persisted for years. Our results are mainly driven by early‐career OB/GYNs and concentrated in densely populated or poor counties. Our results show that Medicaid coverage rules could be an important determinant of physician location choice.

AbstractSchool districts serving newcomer English Learners (ELs) generally offer short‐term intensive English programs designed to teach foundational language skills and guide students’ integration into the U.S. school system. Despite the growing popularity of newcomer programs, however, there is limited rigorous evidence of their efficacy. In this paper, we present evidence on the causal effect of an intensive English program on the academic achievement of newcomer EL students. Access to the program is determined by a test score cutoff which we leverage to employ a regression discontinuity design. On average, students who are eligible for the program in elementary grades experience a boost in their academic achievement for up to 3 years following initial eligibility. Conversely, newcomer EL students who are marginally eligible for intensive English language instruction in middle school grades see a decline in achievement that tends to exacerbate over time.

AbstractWe experimentally analyze the effects of an intervention to induce the renewal of identification cards on access to a government social program in Panamá. On‐time renewals and access to government transfers increased by 10 and 3.6 percentage points, respectively. Simple reminders about expiration dates generated larger effects than also enabling individuals to renew their documents through an online platform, which users struggled to use despite its being designed to simplify the process. The results suggest that increasing access to identity documentation can reduce exclusion errors in social programs and that simply granting access to e‐government platforms may not necessarily improve public service delivery.

AbstractPopulation registries are the gateway to public services, benefits, and rights. However, despite clear formal rules and procedures, people eligible for registration may still face administrative burdens in obtaining access. In this article, we study the case of the municipal registration of people who experience homelessness in Belgium and the Netherlands—a group that typically suffers from administrative vulnerability. Using data from 61 interviews with social workers and civil servants, we find that burdens are constructed at the municipal level to disincentivize homeless people's access to registration. However, using the Institutional Analysis and Development Framework, we also identify mechanisms in the governance of population registrations and the decentralization of social policies that create incentives for strategic behavior by municipal policy makers and street‐level bureaucrats. By analyzing the interaction between multiple institutional levels, we contribute to understanding how structural mechanisms influence policymakers’ agency in the construction of administrative burdens.