Norman Grantham Miller

Norman Grantham Miller

Professor of Medicine, Stanford University
Senior Fellow, Freeman Spogli Institute for International Studies, Stanford University
Senior Fellow, Stanford Institute for Economic Policy Research, Stanford University

Dissertation Title:"Empirical Essays on Major Forces in Health, Population, and Development"

This dissertation investigates several open empirical questions in health, population, and development.

The first chapter addresses ongoing debate about whether or not family planning programs in developing countries reduce fertility or improve socio-economic outcomes. This paper provides new evidence on the role of contraceptive supply by exploiting the surprisingly haphazard expansion of one of the world's oldest and largest family planning organizations--PROFAMILIA of Colombia. Family planning allowed Colombian women to postpone their first birth and have approximately one-half fewer children in their lifetime. It also enabled young women to obtain more education and to work more and live independently later in life. Although family planning explains only about 10% of Colombia's fertility decline, it appears to have reduced the otherwise substantial costs of fertility control and may be among the most effective development interventions.

The second chapter (with David Cutler) investigates the contribution of public health improvements to the enormous health advances of the United States during the early Twentieth Century. Specifically, this paper exploits plausibly exogenous variation in the timing and location of clean water technology adoption to identify the benefits of clean water. We find that clean water was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction. Rough calculations suggest that the rate of return to these technologies was greater than 20 to 1 with a cost per life-year saved of about $500 in 2003 dollars. Implications for developing countries are briefly considered.

Finally, the third chapter (with Srikanth Kadiyala) provides new evidence on how health insurance arrangements influence the use of preventive care by exploiting age discontinuities in the recommended use of preventive cancer screenings. We find that at recommended ages, the probability of being screened increases by two to six percentage points more (or 14% to 70% more) in health maintenance organizations (HMOs) than in indemnity plans, preferred-provider organizations (PPOs), or point-of-service (POS) plans. By implication, HMO enrollment produces an extra year of life for one out 275 enrollees. HMOs appear to achieve these results by contracting selectively with more efficient health care providers. It is also striking how low cancer screening rates are at recommended ages under any insurance arrangement.



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