Grant Miller

All Publications

• Can Bureaucrats Really Be Paid Like Ceos? Substitution Between Incentives and Resources Among School Administrators in China. Journal of the European Economic Association Luo, R., Miller, G., Rozelle, S., Sylvia, S., Vera-Hernández, M. 2020; 18 (1): 165–201

  Abstract

  Unlike performance incentives for private sector managers, little is known about performance incentives for managers in public sector bureaucracies. Through a randomized trial in rural China, we study performance incentives rewarding school administrators for reducing student anemia-as well as complementarity between incentives and orthogonally assigned discretionary resources. Large (but not small) incentives and unrestricted grants both reduced anemia, but incentives were more cost-effective. Although unrestricted grants and small incentives do not interact, grants fully crowd-out the effect of larger incentives. Our findings suggest that performance incentives can be effective in bureaucratic environments, but they are not complementary to discretionary resources.

  View details for DOI 10.1093/jeea/jvy047

  View details for PubMedID 32161517

  View details for PubMedCentralID PMC7053554

• USA aid policy and induced abortion in sub-Saharan Africa: an analysis of the Mexico City Policy. The Lancet. Global health Brooks, N., Bendavid, E., Miller, G. 2019

  Abstract

  BACKGROUND: The Mexico City Policy, first announced by US President Ronald Reagan and since lifted and reinstated by presidents along partisan lines, prohibits US foreign assistance to any organisation that performs or provides counselling on abortion. Many organisations affected by this policy are also providers of modern contraception. If the policy reduces these organisations' ability to supply modern contraceptives, it could have the unintended consequence of increasing abortion rates.METHODS: We empirically examined patterns of modern contraception use, pregnancies, and abortion among women in 26 countries in sub-Saharan Africa in response to the reinstatement and subsequent repeal of the Mexico City Policy across three presidential administrations (William Clinton, George W Bush, and Barack Obama). We combine individual-level data on pregnancies and abortions from 743 691 women, country-year data on modern contraception use, and annual data on development assistance for family planning and reproductive health in a difference-in-difference framework to examine relative changes in use of modern contraception, pregnancy, and abortion in response to the policy.FINDINGS: We found that when the Mexico City Policy was in effect (2001-08), abortion rates rose among women in countries highly exposed to the policy by 4·8 abortions per 10 000 woman-years (95% CI 1·5 to 8·1, p=0·0041) relative to women in low-exposure countries and relative to periods when the policy was rescinded in 1995-2000 and 2009-14, a rise of approximately 40%. We found a symmetric reduction in use of modern contraception by 3·15 percentage points (relative decrease of 13·5%; 95% CI -4·9 to -1·4; p=0·0006) and increase in pregnancies by 3·2 percentage points (relative increase of 12%; 95% CI 1·6 to 4·8; p<0·0001) while the policy was enacted.INTERPRETATION: Our findings suggest that curbing US assistance to family planning organisations, especially those that consider abortion as a method of family planning, increases abortion prevalence in sub-Saharan African countries most affected by the policy.FUNDING: The William and Flora Hewlett Foundation, the Doris Duke Charitable Foundation, the David and Lucile Packard Foundation, and the Stanford Earth Dean's Fellowship.

  View details for DOI 10.1016/S2214-109X(19)30267-0

  View details for PubMedID 31257094

• Population sex imbalance in China before the One-Child Policy DEMOGRAPHIC RESEARCH Babiarz, K., Ma, P., Song, S., Miller, G. 2019; 40: 319–57

  View details for DOI 10.4054/DemRes.2019.40.13

  View details for Web of Science ID 000460557400001

• Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India. Bulletin of the World Health Organization Mohanan, M., Giardili, S., Das, V., Rabin, T. L., Raj, S. S., Schwartz, J. I., Seth, A., Goldhaber-Fiebert, J. D., Miller, G., Vera-Hernández, M. 2017; 95 (5): 343-352E

  Abstract

  To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme - the World Health Partners' Sky Program.We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers' performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models.The programme did not significantly improve health-care providers' knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered.Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.

  View details for DOI 10.2471/BLT.16.179556

  View details for PubMedID 28479635

• Personality Traits and Performance Contracts: Evidence from a Field Experiment among Maternity Care Providers in India AMERICAN ECONOMIC REVIEW Donato, K., Miller, G., Mohanan, M., Truskinovsky, Y., Vera-Hernandez, M. 2017; 107 (5): 506–10

  View details for PubMedID 29553630

• Ambulance Service Associated With Reduced Probabilities Of Neonatal And Infant Mortality In Two Indian States. Health affairs Babiarz, K. S., Mahadevan, S. V., Divi, N., Miller, G. 2016; 35 (10): 1774-1782

  Abstract

  India had no large-scale, centralized emergency medical system or ambulance service until 2005. Since then, the GVK Emergency Management and Research Institute (GVK EMRI) has emerged as India's largest ambulance service provider, covering more than 630 million people. This study provides the first quantitative evidence of GVK EMRI's early impact on population-level infant and maternal health outcomes in Andhra Pradesh and Gujarat, two Indian states with a combined population of about 145 million people. We found that GVK EMRI coverage is associated with reductions in the probability of neonatal and infant mortality as well as delivery complications (statewide in Andhra Pradesh and in high-mortality districts in Gujarat). However, we found little change in the probability of institutional delivery or skilled birth attendance. Taken together, our findings suggest that population-level health gains were achieved through improvements in the quality (rather than quantity) of maternal and neonatal health services-an interpretation consistent with qualitative reports. More research on this topic is needed.

  View details for PubMedID 27702948

• Effect Of A Large-Scale Social Franchising And Telemedicine Program On Childhood Diarrhea And Pneumonia Outcomes In India. Health affairs Mohanan, M., Babiarz, K. S., Goldhaber-Fiebert, J. D., Miller, G., Vera-Hernández, M. 2016; 35 (10): 1800-1809

  Abstract

  Despite the rapid growth of social franchising, there is little evidence on its population impact in the health sector. Similar in many ways to private-sector commercial franchising, social franchising can be found in sectors with a social objective, such as health care. This article evaluates the World Health Partners (WHP) Sky program, a large-scale social franchising and telemedicine program in Bihar, India. We studied appropriate treatment for childhood diarrhea and pneumonia and associated health care outcomes. We used multivariate difference-in-differences models to analyze data on 67,950 children ages five and under in 2011 and 2014. We found that the WHP-Sky program did not improve rates of appropriate treatment or disease prevalence. Both provider participation and service use among target populations were low. Our results do not imply that social franchising cannot succeed; instead, they underscore the importance of understanding factors that explain variation in the performance of social franchises. Our findings also highlight, for donors and governments in particular, the importance of conducting rigorous impact evaluations of new and potentially innovative health care delivery programs before investing in scaling them up.

  View details for PubMedID 27702952

• Population Policy: Abortion and Modern Contraception Are Substitutes. Demography Miller, G., Valente, C. 2016; 53 (4): 979-1009

  Abstract

  A longstanding debate exists in population policy about the relationship between modern contraception and abortion. Although theory predicts that they should be substitutes, the empirical evidence is difficult to interpret. What is required is a large-scale intervention that alters the supply (or full price) of one or the other and, importantly, that does so in isolation (reproductive health programs often bundle primary health care and family planning-and in some instances, abortion services). In this article, we study Nepal's 2004 legalization of abortion provision and subsequent expansion of abortion services, an unusual and rapidly implemented policy meeting these requirements. Using four waves of rich individual-level data representative of fertile-age Nepalese women, we find robust evidence of substitution between modern contraception and abortion. This finding has important implications for public policy and foreign aid, suggesting that an effective strategy for reducing expensive and potentially unsafe abortions may be to expand the supply of modern contraceptives.

  View details for DOI 10.1007/s13524-016-0492-8

  View details for PubMedID 27383846

  View details for PubMedCentralID PMC5016566

• Family Planning Program Effects: Evidence from Microdata POPULATION AND DEVELOPMENT REVIEW Miller, G., Babiarz, K. S. 2016; 42 (1): 7-?

  View details for DOI 10.1111/j.1728-4457.2016.00109.x

  View details for Web of Science ID 000374046200001

• Intended And Unintended Consequences Of China's Zero Markup Drug Policy HEALTH AFFAIRS Yi, H., Miller, G., Zhang, L., Li, S., Rozelle, S. 2015; 34 (8): 1391-1398

  Abstract

  Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. We collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. We found large reductions in drug revenue, as intended by policy makers. However, we also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue.

  View details for DOI 10.1377/hlthaff.2014.1114

  View details for Web of Science ID 000361141000020

• Learning About New Technologies Through Social Networks: Experimental Evidence on Nontraditional Stoves in Bangladesh MARKETING SCIENCE Miller, G., Mobarak, A. M. 2015; 34 (4): 480-499

  View details for DOI 10.1287/mksc.2014.0845

  View details for Web of Science ID 000358307800002

• An exploration of China's mortality decline under Mao: A provincial analysis, 1950-80 POPULATION STUDIES-A JOURNAL OF DEMOGRAPHY Babiarz, K. S., Eggleston, K., Miller, G., Zhang, Q. 2015; 69 (1): 39-56

  Abstract

  Between 1950 and 1980, China experienced the most rapid sustained increase in life expectancy of any population in documented global history. We know of no study that has quantitatively assessed the relative importance of the various explanations proposed for this gain in survival. We have created and analysed a new, province-level panel data set spanning the decades between 1950 and 1980 by combining historical information from China's public health archives, official provincial yearbooks, and infant and child mortality records contained in the 1988 National Survey of Fertility and Contraception. Although exploratory, our results suggest that gains in school enrolment and public health campaigns together are associated with 55-70 per cent of China's dramatic reductions in infant and under-5 mortality during our study period. These results underscore the importance of non-medical determinants of population health, and suggest that, in some circumstances, general education of the population may amplify the effectiveness of public health interventions. Supplementary material for this article (Babiarz et al. 2014, Suppl.) is available at: http://dx.doi.org/10.1080/00324728.2014.972432.

  View details for DOI 10.1080/00324728.2014.972432

  View details for Web of Science ID 000349446200001

  View details for PubMedID 25495509

  View details for PubMedCentralID PMC4331212

• Family Planning: Program Effects International Encyclopedia of the Social and Behavioral Sciences Miller, N. G., Babiarz, K. S. 2015
• Intended And Unintended Consequences Of China's Zero Markup Drug Policy. Health affairs (Project Hope) Yi, H., Miller, G., Zhang, L., Li, S., Rozelle, S. 2015; 34 (8): 1391–98

  Abstract

  Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. We collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. We found large reductions in drug revenue, as intended by policy makers. However, we also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue.

  View details for PubMedID 26240254

• Population Policy: Abortion and Modern Contraception are Substitutes Revise and Resubmit Valente, C., Miller, G. 2015
• Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis BULLETIN OF THE WORLD HEALTH ORGANIZATION Mohanan, M., Bauhoff, S., La Forgia, G., Babiarz, K. S., Singh, K., Miller, G. 2014; 92 (3): 187-194

  Abstract

  To evaluate the effect of the Chiranjeevi Yojana programme, a public-private partnership to improve maternal and neonatal health in Gujarat, India.A household survey (n = 5597 households) was conducted in Gujarat to collect retrospective data on births within the preceding 5 years. In an observational study using a difference-in-differences design, the relationship between the Chiranjeevi Yojana programme and the probability of delivery in health-care institutions, the probability of obstetric complications and mean household expenditure for deliveries was subsequently examined. In multivariate regressions, individual and household characteristics as well as district and year fixed effects were controlled for. Data from the most recent District Level Household and Facility Survey (DLHS-3) wave conducted in Gujarat (n = 6484 households) were used in parallel analyses.Between 2005 and 2010, the Chiranjeevi Yojana programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points; 95% confidence interval, CI: -5.90 to 10.74) or of birth-related complications (6.16 percentage points; 95% CI: -2.63 to 14.95). Estimates using DLHS-3 data were similar. Analyses of household expenditures indicated that mean household expenditure for private-sector deliveries had either not fallen or had fallen very little under the Chiranjeevi Yojana programme.The Chiranjeevi Yojana programme appears to have had no significant impact on institutional delivery rates or maternal health outcomes. The absence of estimated reductions in household spending for private-sector deliveries deserves further study.

  View details for DOI 10.2471/BLT.13.124644

  View details for Web of Science ID 000333577200013

  View details for PubMedID 24700978

  View details for PubMedCentralID PMC3949592

• Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs Encyclopedia of Health Economics in Tony Cuyler (ed.) Miller, G., Babiarz, K. S. 2014
• Learning about New Technologies through Social Networks: Experimental Evidence on Non- Traditional Stoves in Bangladesh Marketing Science Miller, G., Mobaraj, M. 2014; 61 (1)
• The Gorbachev Anti-Alcohol Campaign and Russia's Mortality Crisis AMERICAN ECONOMIC JOURNAL-APPLIED ECONOMICS Bhattacharya, J., Gathmann, C., Miller, G. 2013; 5 (2): 232-260

  Abstract

  Political and economic transition is often blamed for Russia's 40% surge in deaths between 1990 and 1994. Highlighting that increases in mortality occurred primarily among alcohol-related causes and among working-age men (the heaviest drinkers), this paper investigates an alternative explanation: the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign. Using archival sources to build a new oblast-year data set spanning 1978-2000, we find a variety of evidence suggesting that the campaign's end explains a large share of the mortality crisis - implying that Russia's transition to capitalism and democracy was not as lethal as commonly suggested.

  View details for DOI 10.1257/app.5.2.232

  View details for Web of Science ID 000316732800009

  View details for PubMedCentralID PMC3818525

• To Promote Adoption of Household Health Technologies, Think Beyond Health American Journal of Public Health Thurber, M., Warner, C., Platt, L., Slaski, A., Gupta, R., Miller, G. 2013; 103 (1): 1736-174 0
• The Gorbachev Anti-Alcohol Campaign and Russia's Mortality Crisis. American economic journal. Applied economics Bhattacharya, J., Gathmann, C., Miller, G. 2013; 5 (2): 232–60

  Abstract

  Political and economic transition is often blamed for Russia's 40% surge in deaths between 1990 and 1994. Highlighting that increases in mortality occurred primarily among alcohol-related causes and among working-age men (the heaviest drinkers), this paper investigates an alternative explanation: the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign. Using archival sources to build a new oblast-year data set spanning 1978-2000, we find a variety of evidence suggesting that the campaign's end explains a large share of the mortality crisis - implying that Russia's transition to capitalism and democracy was not as lethal as commonly suggested.

  View details for PubMedID 24224067

  View details for PubMedCentralID PMC3818525

• Gender Differences in Preferences, Intra-Household Externalities, and Low Demand for Improved Cookstoves Revise and Resubmit Mobarak, M., Miller, G. 2013
• Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor. American economic journal. Applied economics Miller, G., Pinto, D., Vera-Hernández, M. 2013; 5 (4): 61–91

  Abstract

  Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a "fuzzy" regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services - with measurable health gains.

  View details for PubMedID 25346799

• The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China CESIFO ECONOMIC STUDIES Luo, R., Shi, Y., Zhang, L., Zhang, H., Miller, G., Medina, A., Rozelle, S. 2012; 58 (2): 385-404

  View details for DOI 10.1093/cesifo/ifs023

  View details for Web of Science ID 000304540500008

• HIV Development Assistance and Adult Mortality in Africa JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Bendavid, E., Holmes, C. B., Bhattacharya, J., Miller, G. 2012; 307 (19): 2060-2067

  Abstract

  The effect of global health initiatives on population health is uncertain. Between 2003 and 2008, the US President's Emergency Plan for AIDS Relief (PEPFAR), the largest initiative ever devoted to a single disease, operated intensively in 12 African focus countries. The initiative's effect on all-cause adult mortality is unknown.To determine whether PEPFAR was associated with relative changes in adult mortality in the countries and districts where it operated most intensively.Using person-level data from the Demographic and Health Surveys, we conducted cross-country and within-country analyses of adult mortality (annual probability of death per 1000 adults between 15 and 59 years old) and PEPFAR's activities. Across countries, we compared adult mortality in 9 African focus countries (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia) with 18 African nonfocus countries from 1998 to 2008. We performed subnational analyses using information on PEPFAR's programmatic intensity in Tanzania and Rwanda. We employed difference-in-difference analyses with fixed effects for countries and years as well as personal and time-varying area characteristics.Adult all-cause mortality.We analyzed information on 1 538 612 adults, including 60 303 deaths, from 41 surveys in 27 countries, 9 of them focus countries. In 2003, age-adjusted adult mortality was 8.3 per 1000 adults in the focus countries (95% CI, 8.0-8.6) and 8.5 per 1000 adults (95% CI, 8.3-8.7) in the nonfocus countries. In 2008, mortality was 4.1 per 1000 (95% CI, 3.6-4.6) in the focus countries and 6.9 per 1000 (95% CI, 6.3-7.5) in the nonfocus countries. The adjusted odds ratio of mortality among adults living in focus countries compared with nonfocus countries between 2004 and 2008 was 0.84 (95% CI, 0.72-0.99; P = .03). Within Tanzania and Rwanda, the adjusted odds ratio of mortality for adults living in districts where PEPFAR operated more intensively was 0.83 (95% CI, 0.72-0.97; P = .02) and 0.75 (95% CI, 0.56-0.99; P = .04), respectively, compared with districts where it operated less intensively.Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to nonfocus countries. It was not possible to determine whether PEPFAR was associated with mortality effects separate from reductions in HIV-specific deaths.

  View details for Web of Science ID 000304048200025

  View details for PubMedID 22665105

• China's New Cooperative Medical Scheme Improved Finances Of Township Health Centers But Not The Number Of Patients Served HEALTH AFFAIRS Babiarz, K. S., Miller, G., Yi, H., Zhang, L., Rozelle, S. 2012; 31 (5): 1065-1074

  Abstract

  China's New Cooperative Medical Scheme, launched in 2003, was designed to protect rural households from the financial risk posed by health care costs and to increase the use of health care services. This article reports on findings from a longitudinal study of how the program affected the use of health care services, out-of-pocket spending on medical care, and the operations and financial viability of China's township health centers, which constitute a middle tier of care in between village clinics and county hospitals. We found that between 2005 and 2008 the program provided some risk protection and increased the intensity of inpatient care at township health centers. Importantly, the program appears to have improved the centers' financial status. At the same time, the program did not increase the overall number of patients served or the likelihood that a sick person would seek care at a township center. These findings serve as a benchmark of the program's early impact. The results also suggest that the composition of health care use in China has changed, with people increasingly seeking outpatient care at village clinics and inpatient care at township health centers.

  View details for DOI 10.1377/hlthaff.2010.1311

  View details for Web of Science ID 000303873100023

  View details for PubMedID 22566448

• The Limits of Health and Nutrition Education: Evidence from Three Randomized Controlled Trials in Rural China CESifo Economic Studies Renfu Luo, Yaojiang Shi, Linxiu Zhang, Huiping Zhang, Grant Miller, Alexis Medina, Scott Rozelle 2012; 58 (2): 385-404
• Effectiveness of Provider Incentives for Anaemia Reduction in Rura l China: A Cluster Randomised Trial BMJ Miller, G., Luo, R., Zhang, L., Sylvia, S., Shi, Y., Foo, P., Zhao, Q., Martorell, R., Medina, A., Rozelle, S. 2012; 345
• Low Demand for Nontraditional Cookstove Technologies Proceedings of the National Academy of Sciences USA Miller, G., Mobarak, M., Dwivedi, P., Bailis, R., Hildemann, L. 2012; 109 (27): 10815-10820
• PEPFAR and Adult Mortality - Reply JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Bendavid, E., Holmes, C., Miller, N. G. 2012; 308 (10): 972-973
• Impact of China's New Cooperative Medical Scheme on Township Health Centers Health Affairs Babiarz, K. S., Miller, N. G., Hongmei, Y., Zhang, L., Rozelle, S. 2012; 31 (5): 1065-1074
• United States aid policy and induced abortion in Sub-Saharan Africa BULLETIN OF THE WORLD HEALTH ORGANIZATION Bendavid, E., Avila, P., Miller, G. 2011; 89 (12): 873-880

  Abstract

  To determine whether the Mexico City Policy, a United States government policy that prohibits funding to nongovernmental organizations performing or promoting abortion, was associated with the induced abortion rate in sub-Saharan Africa.Women in 20 African countries who had induced abortions between 1994 and 2008 were identified in Demographic and Health Surveys. A country's exposure to the Mexico City Policy was considered high (or low) if its per capita assistance from the United States for family planning and reproductive health was above (or below) the median among study countries before the policy's reinstatement in 2001. Using logistic regression and a difference-in-difference design, the authors estimated the differential change in the odds of having an induced abortion among women in high exposure countries relative to low exposure countries when the policy was reinstated.The study included 261,116 women aged 15 to 44 years. A comparison of 1994-2000 with 2001-2008 revealed an adjusted odds ratio for induced abortion of 2.55 for high-exposure countries versus low-exposure countries under the policy (95% confidence interval, CI: 1.76-3.71). There was a relative decline in the use of modern contraceptives in the high-exposure countries over the same time period.The induced abortion rate in sub-Saharan Africa rose in high-exposure countries relative to low-exposure countries when the Mexico City Policy was reintroduced. Reduced financial support for family planning may have led women to substitute abortion for contraception. Regardless of one's views about abortion, the findings may have important implications for public policies governing abortion.

  View details for DOI 10.2471/BLT.11.091660

  View details for Web of Science ID 000297885400020

  View details for PubMedID 22271944

  View details for PubMedCentralID PMC3260902

• Anaemia among Students of Rural China's Elementary Schools: Prevalence and Correlates in Ningxia and Qinghai's Poor Counties JOURNAL OF HEALTH POPULATION AND NUTRITION Luo, R., Zhang, L., Liu, C., Zhao, Q., Shi, Y., Miller, G., Yu, E., Sharbono, B., Medina, A., Rozelle, S., Martorell, R. 2011; 29 (5): 471-485

  Abstract

  Although the past few decades have seen rising incomes and increased government attention to rural development, many children in rural China still lack regular access to micronutrient-rich diets. Insufficient diets and poor knowledge of nutrition among the poor result in nutritional problems, including iron-deficiency anaemia, which adversely affect attention and learning of students in school. Little research has been conducted in China documenting the prevalence of nutritional problems among vulnerable populations, such as school-age children, in rural areas. The absence of programmes to combat anaemia among students might be interpreted as a sign that the Government does not recognize its severity. The goals of this paper were to measure the prevalence of anaemia among school-age children in poor regions of Qinghai and Ningxia, to identify individual-, household- and school-based factors that correlate with anaemia in this region, and to report on the correlation between the anaemic status and the physical, psychological and cognitive outcomes. The results of a cross-sectional survey are reported here. The survey involved over 4,000 fourth and fifth grade students from 76 randomly-selected elementary schools in 10 poor counties in rural Qinghai province and Ningxia Hui Autonomous Region, located in the northwest region of China. Data were collected using a structured questionnaire and standardized tests. Trained professional nurses administered haemoglobin (Hb) tests (using Hemocue finger prick kits) and measured heights and weights of children. The baseline data showed that the overall anaemia rate was 24.9%, using the World Health Organization's blood Hb cut-offs of 120 g/L for children aged 12 years and older and 115 g/L for children aged 11 years and under. Children who lived and ate at school had higher rates of anaemia, as did children whose parents worked in farms or were away from home. Children with parents who had lower levels of education were more likely to be anaemic. The anaemic status correlated with the adverse physical, cognitive and psychological outcomes among the students. Such findings are consistent with findings of other recent studies in poor, northwest areas of China and led to conclude that anaemia remains a serious health problem among children in parts of China.

  View details for Web of Science ID 000296910300007

  View details for PubMedID 22106753

  View details for PubMedCentralID PMC3225109

• Anaemia in Rural China's Elementary Schools: Prevalence and Correlates in Ningxia and Qinghai's Poor Counties Journal of Health, Population and Nutrition Luo, R., Zhang, L., Liu, C., Zhao, Q., Shi, Y., Miller, N. G., Yu, E., Sharbano, B., Medina, A., Rozelle, S., Martorell, R. 2011; 29 (5): 471-485
• United States Aid Policy and Induced Abortion in Sub-Saharan Africa Bulletin of the World Health Organization Bendavid, E., Avila, P., Miller, G. 2011; 89: 873-880
• The relation of price of antiretroviral drugs and foreign assistance with coverage of HIV treatment in Africa: retrospective study BRITISH MEDICAL JOURNAL Bendavid, E., Leroux, E., Bhattacharya, J., Smith, N., Miller, G. 2010; 341

  Abstract

  To determine the association of reductions in price of antiretroviral drugs and foreign assistance for HIV with coverage of antiretroviral treatment.Retrospective study.Africa.13 African countries, 2003-8.A price index of first line antiretroviral therapy with data on foreign assistance for HIV was used to estimate the associations of prices and foreign assistance with antiretroviral coverage (percentage of people with advanced HIV infection receiving antiretroviral therapy), controlling for national public health spending, HIV prevalence, governance, and fixed effects for countries and years.Between 2003 and 2008 the annual price of first line antiretroviral therapy decreased from $1177 (£733; €844) to $96 and foreign assistance for HIV per capita increased from $0.4 to $13.8. At an annual price of $100, a $10 decrease was associated with a 0.16% adjusted increase in coverage (95% confidence interval 0.11% to 0.20%; 0.19% unadjusted, 0.14% to 0.24%). Each additional $1 per capita in foreign assistance for HIV was associated with a 1.0% adjusted increase in coverage (0.7% to 1.2%; 1.4% unadjusted, 1.1% to 1.6%). If the annual price of antiretroviral therapy stayed at $100, foreign assistance would need to quadruple to $64 per capita to be associated with universal coverage. Government effectiveness and national public health expenditures were also positively associated with increasing coverage.Reductions in price of antiretroviral drugs were important in broadening coverage of HIV treatment in Africa from 2003 to 2008, but their future role may be limited. Foreign assistance and national public health expenditures for HIV seem more important in expanding future coverage.

  View details for DOI 10.1136/bmj.c6218

  View details for Web of Science ID 000284586600002

  View details for PubMedID 21088074

  View details for PubMedCentralID PMC2987231

• New evidence on the impact of China's New Rural Cooperative Medical Scheme and its implications for rural primary healthcare: multivariate difference-in-difference analysis BRITISH MEDICAL JOURNAL Babiarz, K. S., Miller, G., Yi, H., Zhang, L., Rozelle, S. 2010; 341

  Abstract

  To determine whether China's New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics.We performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects.100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007. Participants 160 village primary care clinics and 8339 individuals.Clinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual "out of pocket" health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets).For village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages.NCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.

  View details for DOI 10.1136/bmj.c5617

  View details for Web of Science ID 000283553200002

  View details for PubMedID 20966008

• The US Global Health Initiative Informing Policy With Evidence JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Bendavid, E., Miller, G. 2010; 304 (7): 791-792

  View details for PubMedID 20716743

• Y Contraception as Development? New Evidence from Family Planning in Colombia* ECONOMIC JOURNAL Miller, G. 2010; 120 (545): 709-736

  View details for DOI 10.1111/j.1468-0297.2009.02306.x

  View details for Web of Science ID 000278307700006

• Cyclicality, Mortality, and the Value of Time: The Case of Coffee Price Fluctuations and Child Survival in Colombia JOURNAL OF POLITICAL ECONOMY Miller, G., Urdinola, B. P. 2010; 118 (1): 113-155

  Abstract

  Recent studies demonstrate procyclical mortality in wealthy countries, but there are reasons to expect a countercyclical relationship in developing nations. We investigate how child survival in Colombia responds to fluctuations in world Arabica coffee prices - and document starkly procyclical child deaths. In studying this result's behavioral underpinnings, we highlight that: (1) The leading determinants of child health are inexpensive but require considerable time, and (2) As the value of time declines with falling coffee prices, so does the relative price of health. We find a variety of direct evidence consistent with the primacy of time in child health production.

  View details for Web of Science ID 000275493600004

  View details for PubMedCentralID PMC3214991

• New Evidence on the Impact of China's New Cooperative Medical Scheme and Its Implications for Rural Primary Care BMJ Babiarz, K. S., Miller, N. G., Yi, H., Zhang, L., Rozelle, S. 2010; 341 (c5617)
• AIDS and Declining Support for Africa’s Dependent Elderly: A Retrospective Analysis Using Demographic and Health Surveys BMJ Kautz, T., Bendavid, E., Bhattacharya, J., Miller, G. 2010; 340 (C2841)
• Cyclicality, Mortality, and the Value of Time: The Case of Coffee Price Fluctuations and Child Survival in Colombia Journal of Political Economy Miller NG, Urdinola P 2010; 118 (1): 113-155
• Contraception as Development? New Evidence from Family Planning in Colombia Economic Journal Miller NG 2010; 120 (545): 709-736
• The U.S. Global Health Initiative: Informing Policy with Evidence [Commentary], Journal of the American Medical Association Bendavid E, Miller NG 2010; 304 (7): 791-792
• The Relation of Price of Antiretroviral Drugs and Foreign Assistance with Coverage of HIV Treatment in Africa: Retrospective Study BMJ Bendavid, E., Leroux, E., Bhattacharya, J., Miller, N. G. 2010; 341 (c6218)
• Women's suffrage, political responsiveness, and child survival in American history QUARTERLY JOURNAL OF ECONOMICS Miller, G. 2008; 123 (3): 1287-1327

  Abstract

  Women's choices appear to emphasize child welfare more than those of men. This paper presents new evidence on how suffrage rights for American women helped children to benefit from the scientific breakthroughs of the bacteriological revolution. Consistent with standard models of electoral competition, suffrage laws were followed by immediate shifts in legislative behavior and large, sudden increases in local public health spending. This growth in public health spending fueled large-scale door-to-door hygiene campaigns, and child mortality declined by 8-15% (or 20,000 annual child deaths nationwide) as cause-specific reductions occurred exclusively among infectious childhood killers sensitive to hygienic conditions.

  View details for Web of Science ID 000257950000010

  View details for PubMedCentralID PMC3046394

• Women's Suffrage, Political Responsiveness, and Child Survival in American History Quarterly Journal of Economics Miller, N. G. 2008; 123 (3): 1287-1327
• Evidence on early-life income and late-life health from America's Dust Bowl era PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Cutler, D. M., Miller, G., Norton, D. M. 2007; 104 (33): 13244-13249

  Abstract

  In recent decades, elderly Americans have enjoyed enormous gains in longevity and reductions in disability. The causes of this progress remain unclear, however. This paper investigates the role of fetal programming, exploring how economic progress early in the 20th century might be related to declining disability today. Specifically, we match sudden unexpected economic changes experienced in utero in America's Dust Bowl during the Great Depression to unusually detailed individual-level information about old-age disability and chronic disease. We are unable to detect any meaningful relationship between early life factors and outcomes in later life. We conclude that, if such a relationship exists in the United States, it is most likely not a quantitatively important explanation for declining disability today.

  View details for DOI 10.1073/pnas.0700035104

  View details for Web of Science ID 000248899600008

  View details for PubMedID 17686988

  View details for PubMedCentralID PMC1948901

• Evidence on Early-Life Income and Late-Life Health from America?s Dust Bowl Era Proceedings of the National Academy of Sciences USA Cutler, D., Miller, NG, Norton D 2007; 104 (33): 13244-13249
• Water, Water Everywhere: Municipal Finance and Water Supply in American Cities. in Edwards Glaeser and Claudia Goldin (eds.), Corruption and Reform: Lessons from America's History Cutler, D., Miller, G. 2006: 153-184
• The Role of Public Health Improvements in Health Advances: The 20th Century United States Demography Cutler D, Miller NG 2005; 42 (1): 1-22
• The Impact of Medicaid Managed Care on Community Clinics in Sacramento County, California American Journal of Public Health Korenbrot CC, Miller NG, Greene J 1999; 89 (6): 913-17