NBER Working Papers by Grant Miller

Despite current emphasis on health insurance expansions in developing countries, inefficient consumer incentives for over-use of medical care are an important counterbalancing concern. However, three factors that are more acute in poor countries (credit constraints, principal-agent problems, and positive externalities) result in substantial under-use and misuse as well. This paper studies Colombia’s Régimen Subsidiado, the first major developing country effort to expand insurance in a way that purposefully addresses these inefficiencies. Using a regression discontinuity design, we find that Colombia’s insurance program has provided risk protection while substantially increasing the use of traditionally under-utilized preventive services (with measurable health gains) through high-powered s...

There has been considerable debate in the last decade about whether or not family planning programs in developing countries reduce fertility or improve socio-economic outcomes. Despite suggestive associations, disagreement persists because the availability and use of modern contraceptives are generally determined by both supply- and demand-side factors. This paper provides new evidence on the role of contraceptive supply by exploiting the surprisingly haphazard expansion of one of the world%u2019s oldest and largest family planning organizations %uF818 PROFAMILIA of Colombia. Its findings suggest that family planning allowed Colombian women to postpone their first birth and have approximately one-half fewer children in their lifetime. Delayed first births, in turn, seem to have enabled yo...

The construction of municipal water systems was a major event in the history of American cities -- bringing relief from disease, providing resources to combat fires, attracting business investment, and promoting development generally. Although the first large-scale municipal water system in the United States was completed in 1801, many American cities lacked waterworks until the turn of the twentieth century. This paper investigates the reason for the century-long delay and the subsequent frenzy of waterworks construction from 1890 through the 1920s. We propose an explanation that emphasizes the development of local public finance. Specifically, we highlight the importance of municipal bond market growth as a facilitator of debt finance. We argue that this explanation is superior to others...

Mortality rates in the US fell more rapidly during the late 19th and early 20th Centuries than any other period in American history. This decline coincided with an epidemiological transition and the disappearance of a mortality "penalty" associated with living in urban areas. There is little empirical evidence and much unresolved debate about what caused these improvements, however. This paper investigates the causal influence of clean water technologies - filtration and chlorination - on mortality in major cities during the early 20th Century. Plausibly exogenous variation in the timing and location of technology adoption is used to idetify these effects, and the validity of this identifying assumption is examined in detail. We find that clean water was responsible for nearly half of t...