School nutrition policies aim to eliminate ubiquitous unhealthy foods and beverages from schools to improve adolescent dietary behavior and reduce childhood obesity. This paper evaluates the impact of an early nutrition policy, Los Angeles Unified School District's food-and-beverage standards of 2004, using two large datasets on food intake and physical measures. I implement cohort and cross-section estimators using ``synthetic'' control groups, combinations of unaffected districts that are reweighted to closely resemble the treatment unit in the pre-intervention period. The results indicate that the policy was mostly ineffective at reducing the prevalence of overweight or obesity 8-15 months after the intervention but significantly decreased consumption of two key targets, soda and fried foods. The policy's impact on physical outcomes appears to be mitigated by substitution toward foods that are still (or newly) available in the schools.
Yoong, Joanne, Kata Mihaly, Sebastian Bauhoff, Lila Rabinovich, and Angela Hung. 2013. Toolkit for the Evaluation of Financial Capability Programs in Low and Middle-Income Countries. Washington DC: World Bank. Published report (open access)
Bauhoff, Sebastian, Katherine Carman, and Amelie Wuppermann. 2013. “Financial Literacy and Consumer Choice of Health Insurance: Evidence from Low-Income Populations in the United States.” RAND Working Paper Series WR-1013. Current draft on SSRN Abstract

Under the U.S. Affordable Care Act (ACA), many low income consumers will become eligible for government support to buy health insurance. Whether these consumers are able to take advantage of the support and to make sound decisions about purchasing health insurance will likely depend on their knowledge and skills in navigating complex financial products. This ability is frequently referred to as “financial literacy.” This paper examined the level and distribution of consumers’ financial literacy across income groups, using 2012 data collected in the RAND American Life Panel, an internet panel representative of the U.S. population. Financial illiteracy was particularly prevalent among individuals with incomes between 100-400% of the Federal Poverty Line, many of whom will be eligible for subsidies. In this group, the young, less educated, females, and those with less income were more likely to have low financial literacy. The findings suggest the need for targeted policies to support vulnerable consumers in making good choices for themselves, possibly above and beyond the support measures already planned for in the ACA.

Bauhoff, Sebastian. 2012. “Do Health Plans Risk-Select? An Audit Study on Germany’s Social Health Insurance.” Journal of Public Economics 96 (9-10): 750–759. Published paper (gated) Abstract

This paper evaluates whether health plans in Germany's Social Health Insurance select on an easily observable predictor of risk: geography. To identify plan behavior separately from concurrent demand-side adverse selection, I implement a double-blind audit study in which plans are contacted by fictitious applicants from different locations. I find that plans are less likely to respond and follow-up with applicants from higher-cost regions, such as West Germany. The results suggest that supply-side selection may emerge even in heavily regulated insurance markets. The prospect of risk selection by firms has implications for studies of demand-side selection and regulatory policy in these settings.

Prepublication draft

Objective. To evaluate provider responsiveness and beneficiary satisfaction with insurance carriers participating in the Republic of Georgia’s Medical Insurance for the Poor.

Study setting. A dedicated survey of approximately 3,500 households in two types of regions – with different eligibility thresholds – in November and December 2008.

Study design. Regression-based estimation of responsiveness ratings by beneficiaries and non-beneficiaries of the insurance program and estimation of mean satisfaction scores for beneficiaries.

Principal findings. In the high-threshold regions, provider responsiveness toward beneficiaries and non-beneficiaries is comparable. In the low-threshold regions, beneficiary status is associated with lower responsiveness of outpatient providers. Inpatient providers may have become less responsive toward beneficiaries during the program’s transition from public to private administration. While satisfaction of beneficiaries with carriers is above average, there are reports of difficulties obtaining reimbursement and information about benefits.

Conclusions. The results suggest that relying on private insurance companies to deliver public programs in middle-income settings may impact provider responsiveness and indicates the need for continuous monitoring and regulation.

McGuire, Thomas, and Sebastian Bauhoff. 2011. “Adoption of a Cost-Saving Innovation: Germany, UK and Simvastatin.” England and Germany in Europe – What Lessons Can We Learn from Each Other?, edited by Klusen, N., F Verheyen, and C Wagner, 11-26. Baden-Baden, Germany: Nomos Verlag. Abstract

We examine how the UK and German health care systems responded to a major cost-saving innovation: the availability of generic simvastatin, a cho¬lesterol-lowering drug. In the German Social Health Insurance, the generic’s entry reduced sales volumes for both branded simvastatin (Zocor) and a close substitute, branded atorvastatin (Lipitor/Sortis). In UK, only the sales of branded simvastatin fell whereas the sales of atorvastatin were mostly unaf¬fected. We trace these experiences to institutional differences in the two health care systems and to the structure of patient cost-sharing in particular.

Prepublication draft
Bauhoff, Sebastian. 2011. “Systematic Self-Report Bias in Health Data: Impact on Estimating Cross-Sectional and Treatment Effects.” Health Services and Outcomes Research Methodology 11 (1-2): 44-53. Published paper (gated) Abstract

This paper examines the effect of systematic self-report bias, the non-random deviation between the self-reported and true values of the same measure. This bias may be constant or variable, and can mislead empirical analyses based on descriptive statistics, program evaluation and instrumental variables estimation. I illustrate these issues with data on self-reported and measured overweight/obesity status, and BMI, height and weight z-scores of public school students in California from 2004 to 2006. I find that the prevalence of overweight/obesity is 2.4–7.6 percentage points lower in self-reported data relative to measured data in the cross-section. A school nutrition policy changed the bias differentially in the treatment and control groups so that program evaluations could find spurious positive or null impacts of the intervention. Potential channels for this effect include improved information and stigma.

Bauhoff, Sebastian, David R Hotchkiss, and Owen Smith. 2011. “The Impact of Medical Insurance for the Poor in Georgia: A Regression Discontinuity Approach.” Health Economics 20 (11): 1362–1378. Published paper (gated) Abstract

Improving access to health care and financial protection of the poor is a key concern for policymakers in low- and middle-income countries, but there have been few rigorous program evaluations. The Medical Insurance Program for the Poor in the republic of Georgia provides a free and extensive benefit package and operates through a publicly funded voucher program, enabling beneficiaries to choose their own private insurance company. Eligibility is determined by a proxy means test administered to applicant households. The objective of this study is to evaluate the program's impact on key outcomes including utilization, financial risk protection, and health behavior and management. A dedicated survey of approximately 3500 households around the thresholds was designed to minimize unobserved heterogeneity by sampling clusters with both beneficiary and non-beneficiary households. The research design exploits the sharp discontinuities at two regional eligibility thresholds to estimate local average treatment effects. Results suggest that the program did not affect utilization of health services but decreased mean out-of-pocket expenditures for some groups and reduced the risk of high inpatient expenditures. There are no systematic impacts on health behavior, management of chronic illnesses, and patient satisfaction.

McGuire, Thomas, and Sebastian Bauhoff. 2007. “A Decade of Choice: Tracking the German National Experience with Consumer Choice of Sickness Fund.” Auf der Suche Nach der Besseren Lösung, edited by P Oberender and C Straub, 145-159. Baden-Baden, Germany: Nomos Verlag.
Prepublication draft