The impact of managed care and conditional cash transfers on the health of low-income children (California, Mexico)

It is well known that good health as a child has important implications for a person's welfare. Governments have thus often targeted young children in an effort to improve life-time health outcomes. This dissertation explores the success of two government policies in bettering the health of poor children: managed health care in the United States and cash transfers conditional on health care utilization in Mexico.; The first chapter investigates whether mandating a managed care option for California Medicaid beneficiaries improves access to prenatal care and birth outcomes in a traditionally fee-for-service system. We compare two competing models: one that only offers a county-organized health system option (COHS), and the Two Plan Model (TPC) that provides mothers with a choice between the county system and a commercial managed care organization. The results show that while COHS improved access, only the TPC program led to reductions in low-birth weight. The superior health outcomes obtained with TPC might be explained by higher quality care induced by competition among health providers and/or mainstreaming Medi-Cal beneficiaries into commercial organizations that also serve higher income populations.; Chapter two investigates the impact of the Mexican conditional cash transfer program, Progresa, on infant mortality using municipal-level data. We find that Progresa led to an 11 percent decline in rural infant mortality among treated households. Given the relatively high incidence of infant mortality in rural areas, and that it fell by less than one percent a year over the five years before Progresa, this is an important decline. Reductions were even higher in communities where the population all spoke some Spanish and had better access to piped water.; Chapter three uses a randomized experiment to determine the impact of Progresa on vaccination coverage. Due to high overall immunization rates in Mexico, Progresa increased vaccination rates by less than five percent. This impact was more important for children with less educated mothers and those who lived further away from a health clinic.