Under pressure? Forced migration and public health

Marques, Renan and Maciel, Mateus and Zuchowski, David (2025): Under pressure? Forced migration and public health.

Abstract

We study how Venezuelan refugee inflows affect healthcare outcomes and municipal public finances in Brazil's universal, decentralized public healthcare system. For identification, we exploit cross-municipality variation in refugee exposure and use distance to Brazil's only official border crossing with Venezuela as an instrument. A one-percentage-point increase in the local refugee share raises overall mortality by 4.2 percent and infant mortality by up to 9 percent. We show these effects operate through both the poorer baseline health of arriving refugees and congestion in local health facilities. Municipalities increase the share of spending on healthcare, but absent compensating federal transfers, they do so at the expense of education's budget share. These results highlight the limits of decentralized service provision in absorbing the health and fiscal costs of concentrated migration shocks.

• Item Type: MPRA Paper
• Language: English
• Keywords: Forced migration, refugees, public health, Brazil
• Subjects: H - Public Economics > H4 - Publicly Provided Goods > H41 - Public Goods; H - Public Economics > H5 - National Government Expenditures and Related Policies > H51 - Government Expenditures and Health; H - Public Economics > H7 - State and Local Government ; Intergovernmental Relations > H72 - State and Local Budget and Expenditures; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; O - Economic Development, Innovation, Technological Change, and Growth > O1 - Economic Development > O15 - Human Resources ; Human Development ; Income Distribution ; Migration

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