Incomplete take-up of the Earned Income Tax Credit (EITC) is a source of persistent policy concern, with an estimated one-fifth of eligible households failing to claim the credit. To promote take-up, a growing number of jurisdictions require employers to provide EITC information to employees. We study the effect of these requirements, linking state and time variation in the adoption of the notification laws to admin- istrative tax data. Our preferred specification yields precise null effects on EITC claiming, filing behavior, and labor force participation. The results cast doubt on the effectiveness of the notice requirements as implemented and suggest further research into other avenues for increasing tax benefit take-up.

China has one of the highest rates of antibiotic resistance. Existing studies document high rates of antibiotic prescription by primary care providers but there is little direct evidence on clinically inappropriate use of antibiotics or the drivers of antibiotic prescription. To assess clinically inappropriate antibiotic prescriptions among rural primary care providers, we employed unannounced standardized patients (SPs) who presented three fixed disease cases, none of which indicated antibiotics. We compared antibiotic prescriptions of the same providers in interactions with SPs and matching vignettes assessing knowledge of diagnosis and treatment to assess overprescription attributable to deficits in diagnostic knowledge, therapeutic knowledge and factors that lead providers to deviate from their knowledge of best practice. Overall, antibiotics were inappropriately prescribed in 221/526 (42%) SP cases. Compared with SP interactions, prescription rates were 29% lower in matching clinical vignettes (42% versus 30%, P , 0.0001). Compared with vignettes assessing diagnostic and therapeutic knowledge jointly, rates were 67% lower in vignettes with the diagnosis revealed (30% versus 10%, P , 0.0001). Antibiotic prescription in vignettes was inversely related to measures of diagnostic process quality (completion of checklists). Clinically inappropriate antibiotic prescription is common among primary care providers in rural China. While a large proportion of overprescription may be due to factors such as financial incentives tied to drug sales and perceived patient demand, our findings suggest that deficits in diagnostic knowledge are a major driver of unnecessary antibiotic prescriptions. Interventions to improve diagnostic capacity among providers in rural China are needed.

Health insurance in the United States is fragmented. Americans, and especially low-income groups, receive their insurance coverage through numerous plans throughout their lives and even at one point in time, their coverage benefits can be outsourced to different insurers. This study presents empirical, causal evidence showing that such fragmentation reduces the incentives for any one plan to invest in preventative health. Specifically, I study a policy in New York’s Medicaid that carved out very low birthweight newborns from the responsibilities of private plans and placed them under the public state insurance program. Once the carve-out ended in 2012 and private plans became liable for the costs of very low birthweight newborns, pregnant enrollees covered by these plans experienced more preventative care that is specifically targeted towards monitoring and reducing the risk of preterm and low birthweight newborns. These increases were above and beyond secular changes in care experienced by pregnant enrollees in the public program. Moreover, the largest gains appear among African American enrollees and enrollees with a high risk of delivering a preterm and a low birthweight newborn, suggesting that the fragmented regime had not just underallocated prevention but also misallocated it.

One in four people in the United States has health insurance that is funded by public taxes and administered by private insurance. The amount of funding that private insurers receive is typically adjusted on the health of the enrollee where sicker enrollees bring in higher revenues. This paper examines the prospects for a new regime that risk adjusts insurer payment on the health as well as the socioeconomic characteristics of the enrollees. Specifically, we study a change in Medicare’s risk adjustment system in 2017, where private Medicare Advantage plans started receiving an additional $1,416 about 10% of the baseline annual revenues for each low-income beneficiary they enroll. We find no evidence that the policy succeeded in attracting low-income groups to private plans. However, about one third of the targeted low-income population was already enrolled in Medicare Advantage and experienced more generous supplemental benefit coverage under the new regime. We also show suggestive evidence that plans that entered the market post-policy were more competitive in terms of their coverage and their spending on their enrollees.