The effects of health spending on the propagation of infectious diseases.

We explore the discontinuity in the allocation of the main federal grant to Brazilian municipalities to identify the local effects of health spending and the spillovers into the bordering jurisdictions. Fiscal reactions are asymmetric: small neighbors reduce health spending, while we do not find a significant budgetary response in the largest neighbor. Our results suggest a reduction in the spread of infectious diseases in the neighbors, with fewer residents hospitalized with gastrointestinal infections. In addition, the elderly demand less hospitalization in the largest bordering jurisdictions due to respiratory infectious diseases. Finally, we find a direct and significant reduction in infant mortality, consistent with the observed pediatricians' increase, while the spillover effects on neighbors' mortality rates are not conclusive.

Assessing the impact of More Doctors Program on health care indicators

This paper aims to assess the short run effects of the More Doctors Program, launched by the Brazilian federal government in 2013. Using differences-in-differences approach with municipal data collected between 2010 and 2015, we confirm that MDP has two correlated impacts. First, it has increased health service attendance on treated municipalities. We document that appointments, consults, referrals, and home visits have increased by 5.9%, 9.4%, 12.3%, and 29.7%. Second, we find a negative impact on hospitalization. We argue that intensification on health service access have reduced general hospitalization (4.6%). However, it does not seem to have been able to reduce mortality in the municipalities, in line with Carrilo and Feres (2018) and Fontes et al. (2017). We argue that increase in referrals and appointment with specialists can be interpreted as quality improvement, since a more precise diagnostic, can reduce hospitalization due to faster health recovery without an impact on mortality.

Descentralização e provisão de serviços públicos: evidências a partir da criação dos municípios brasileiros no setor de saneamento básico / Decentralization and provision of public services : evidence from Brazilian municipalities secession on sanitation services

Este trabalho investiga se a descentralização política, representada pela criação de novos municípios ocorrida no Brasil após a promulgação da Constituição de 1988, impacta sobre os investimentos em abastecimento de água. Em particular, testamos se as hipóteses de que a maior proximidade entre gestores públicos e cidadãos e a concorrência entre governos locais, decorrentes da descentralização resultam em uma melhor adequação do serviço de saneamento básico ofertado para a população local. Usando o método de Diferenças em Diferenças, encontramos evidências que o desmembramento de municípios resultou em expansão dos investimentos (R$220 reais per capita a mais em relação aos demais da mesma micro-região) e que estes desmembrados respondem a níveis de cobertura comparativamente inferiores aos de municípios do entorno. No entanto, tal efeito não é encontrado para a resposta nas qualidades dos serviços de saneamento. Por fim, estimamos que municípios novos respondem 12% a mais em investimento (relativo ao entorno) que respectivos municípios de origem.

This work investigates whether the political decentralization represented by the creation of new municipalities in Brazil impacts on investments in sanitation services. In particular, we test the hypotheses that the greater proximity between public officials and citizens as a result of decentralization, leads to a better matching of the sanitation service offered to local people. Using the method of difference in differences, we find evidence that the creation of municipalities lead to an expansion of investments (R$220 reais per capita larger compared to those in the same micro-região)) and that they respond to coverage levels comparatively lower than in neighboring municipalities. However, this effect is not found for the response in the quality of sanitation services. Last, we estimate that new municipalities do respond more 12% more in relative (neighbor's) investments in that sector compared to the origin's municipalities