Who’s declining the “free lunch”? New evidence from the uptake of public child dental benefits

Nguyen, Ha Trong and Le, Huong Thu and Connelly, Luke B. (2019): Who’s declining the “free lunch”? New evidence from the uptake of public child dental benefits.

Abstract

Recent economic literature has advanced the notion that cognitive biases and behavioural barriers may be important influencers of uptake decisions in respect of public programs that are designed to help disadvantaged people. This paper provides the first evidence on the determinants of uptake of two recent public dental benefit programs for Australian children and adolescents from disadvantaged families. Using longitudinal data from a nationally representative survey linked to administrative data with accurate information on eligibility and uptake, we find that only a third of all eligible families actually claim their benefits. These actual uptake rates are about half of the targeted access rates that were announced for them. We provide new and robust evidence consistent with the idea that cognitive biases and behavioural factors are barriers to uptake. For instance, mothers with worse mental health or riskier lifestyles are much less likely to claim the available benefits for their children. These barriers to uptake are particularly large in magnitude: together they reduce the uptake rate by up to 10 percentage points (or 36%). We also find some indicative evidence that a lack of information is a barrier to uptake. The results are robust to a wide range of sensitivity checks, including controlling for possible endogenous sample selection.

• Item Type: MPRA Paper
• Language: English
• Keywords: Government Programs; Impact Evaluation, Dental Health, Provision and Effects of Welfare Programs, Australia, Uptake, Take-up
• Subjects: D - Microeconomics > D1 - Household Behavior and Family Economics; H - Public Economics > H5 - National Government Expenditures and Related Policies > H51 - Government Expenditures and Health; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; I - Health, Education, and Welfare > I3 - Welfare, Well-Being, and Poverty > I38 - Government Policy ; Provision and Effects of Welfare Programs

References

AIFS, 2018. Longitudinal Study of Australian Children Release 7.0 (Waves 1-7): Data user guide. Australian Institute of Family Studies

Aizer, A., 2007. Public Health Insurance, Program Take-Up, and Child Health. The Review of Economics and Statistics 89, 400-415

Aizer, A., Currie, J., 2004. Networks or neighborhoods? Correlations in the use of publicly-funded maternity care in California. Journal of Public Economics 88, 2573-2585

Almond, D., Currie, J., 2011. Chapter 15 - Human Capital Development before Age Five. In: Orley A & David C (eds.) Handbook of labor economics. Elsevier, pp. 1315-1486.

Altmann, S., Traxler, C., 2014. Nudges at the dentist. European Economic Review 72, 19-38

ANAO, 2015. Administration of the Child Dental Benefits Schedule. The Australian National Audit Office (ANAO) Report No.12 2015–16

Anderson, P.M., Meyer, B.D., 1997. Unemployment insurance takeup rates and the after-tax value of benefits. The Quarterly Journal of Economics 112, 913-937

Armour, P., 2018. The Role of Information in Disability Insurance Application: An Analysis of the Social Security Statement Phase-In. American Economic Journal: Economic Policy 10, 1-41

Barlow, P., McKee, M., Reeves, A., Galea, G., Stuckler, D., 2017. Time-discounting and tobacco smoking: a systematic review and network analysis. International journal of epidemiology 46, 860-869

Barr, A., Turner, S., 2018. A Letter and Encouragement: Does Information Increase Postsecondary Enrollment of UI Recipients? American Economic Journal: Economic Policy 10, 42-68

Bayer, Y.a.M., Shtudiner, Z., Suhorukov, O., Grisaru, N., 2019. Time and risk preferences, and consumption decisions of patients with clinical depression. Journal of Behavioral and Experimental Economics 78, 138-145

Bertrand, M., Karlan, D., Mullainathan, S., Shafir, E., Zinman, J., 2010. What's Advertising Content Worth? Evidence from a Consumer Credit Marketing Field Experiment. The Quarterly Journal of Economics 125, 263-306

Bertrand, M., Mullainathan, S., Shafir, E., 2006. Behavioral economics and marketing in aid of decision making among the poor. Journal of Public Policy & Marketing 25, 8-23

Bettinger, E.P., Long, B.T., Oreopoulos, P., Sanbonmatsu, L., 2012. The Role of Application Assistance and Information in College Decisions: Results from the H&R Block Fafsa Experiment. The Quarterly Journal of Economics 127, 1205-1242

Bhargava, S., Manoli, D., 2015. Psychological Frictions and the Incomplete Take-Up of Social Benefits: Evidence from an IRS Field Experiment. American Economic Review 105, 3489-3529

Black, S.E., Devereux, P.J., 2011. Chapter 16 - Recent Developments in Intergenerational Mobility. In: David C & Orley A (eds.) Handbook of Labor Economics, Volume 4, Part B. pp. 1487-1541.

Blank, R.M., Ruggles, P., 1996. When Do Women Use Aid to Families with Dependent Children and Food Stamps? The Dynamics of Eligibility Versus Participation. The Journal of Human Resources 31, 57-89

Blundell, R., Fry, V., Walker, I., 1988. Modelling the Take-up of Means-Tested Benefits: The Case of Housing Benefits in the United Kingdom. The Economic Journal 98, 58-74

Brown, H., van der Pol, M., 2015. Intergenerational transfer of time and risk preferences. Journal of Economic Psychology 49, 187-204

Buchmueller, T., Miller, S., Vujicic, M., 2016. How Do Providers Respond to Changes in Public Health Insurance Coverage? Evidence from Adult Medicaid Dental Benefits. American Economic Journal: Economic Policy 8, 70-102

Carroll, G.D., Choi, J.J., Laibson, D., Madrian, B.C., Metrick, A., 2009. Optimal Defaults and Active Decisions. The Quarterly Journal of Economics 124, 1639-1674

Chareyron, S., Domingues, P., 2018. Take-Up of Social Assistance Benefits: The Case of the French Homeless. Review of Income and Wealth 64, 170-191

Currie, J., 2006. The take up of social benefits. In: Auerbach A, Card D & Quigley J (eds.) Poverty, the Distribution of Income, and Public Policy. Russell Sage, New York, pp. 80-148.

Currie, J., Grogger, J., 2002. Medicaid expansions and welfare contractions: offsetting effects on prenatal care and infant health? Journal of Health Economics 21, 313-335

Currie, J., Thomas, D., 1995. Does Head Start Make a Difference? The American Economic Review 85, 341-364

Dahl, G.B., Løken, K.V., Mogstad, M., 2014. Peer Effects in Program Participation. American Economic Review 104, 2049-74

Daponte, B.O., Sanders, S., Taylor, L., 1999. Why do low-income households not use food stamps? Evidence from an experiment. Journal of Human resources 34, 612-613

Deshpande, M., Li, Y., 2019. Who Is Screened Out? Application Costs and the Targeting of Disability Programs. American Economic Journal: Economic Policy 11, 213–248

Dizon-Ross, R., 2019. Parents' Beliefs About Their Children's Academic Ability: Implications for Educational Investments. American Economic Review 109, 2728-65

DoH, 2009. Report on the Review of the Dental Benefits Act 2008. Department of Health (DoH), Australian Government

DoH, 2012. Report on the Second Review of the Dental Benefits Act 2008. Department of Health (DoH), Australian Government

DoH, 2016. Report on the Third Review of the Dental Benefits Act 2008. Department of Health (DoH), Australian Government

DoH, 2019a. The Child Dental Benefits Schedule. Australian Government Department of Health (DoH): http://www.health.gov.au/internet/main/publishing.nsf/content/childdental (assessed: 27/11/2019)

DoH, 2019b. Guide to the Child Dental Benefits Schedule (version 7). Australian Government Department of Health (DoH), http://www.health.gov.au/internet/main/publishing.nsf/content/childdental (assessed: 27/11/2019)

DoHS, 2019. A guide to Australian Government payments. Australian Government Department of Human Services (DoHS), https://www.humanservices.gov.au, (assessed: 27/11/2019)

Duflo, E., Kremer, M., Robinson, J., 2011. Nudging Farmers to Use Fertilizer: Theory and Experimental Evidence from Kenya. American Economic Review 101, 2350-90

Finkelstein, A., Notowidigdo, M.J., 2019. Take-up and Targeting: Experimental Evidence from SNAP. The Quarterly Journal of Economics 134, 1505–1556

Friedrichsen, J., König, T., Schmacker, R., 2018. Social image concerns and welfare take-up. Journal of Public Economics 168, 174-192

Gnanamanickam, E.S., Teusner, D.N., Arrow, P.G., Brennan, D.S., 2018. Dental insurance, service use and health outcomes in Australia: a systematic review. Australian Dental Journal 63, 4-13

Guyton, J., Langetieg, P., Manoli, D., Payne, M., Schafer, B., Sebastiani, M., 2017. Reminders and Recidivism: Using Administrative Data to Characterize Nonfilers and Conduct EITC Outreach. American Economic Review: Papers and Proceedings 107, 471-75

Hastings, J.S., Weinstein, J.M., 2008. Information, School Choice, and Academic Achievement: Evidence from Two Experiments. The Quarterly Journal of Economics 123, 1373-1414

Heckman, J.J., 1979. Sample Selection Bias as a Specification Error. Econometrica 47, 153-162

Holford, A., 2015. Take‐up of Free School Meals: Price Effects and Peer Effects. Economica 82, 976-993

Hoynes, H., Schanzenbach, D.W., 2016. US food and nutrition programs. In: Moffitt RA (ed.) Economics of Means-Tested Transfer Programs in the United States, Volume 1. University of Chicago Press, pp. 219-301.

Karlan, D., McConnell, M., Mullainathan, S., Zinman, J., 2016. Getting to the Top of Mind: How Reminders Increase Saving. Management Science 62, 3393-3411

Kleven, H.J., Kopczuk, W., 2011. Transfer Program Complexity and the Take-Up of Social Benefits. American Economic Journal: Economic Policy 3, 54-90

Kumar, S., Tadakamadla, J., Johnson, N.W., 2016. Effect of Toothbrushing Frequency on Incidence and Increment of Dental Caries:A Systematic Review and Meta-Analysis. Journal of Dental Research 95, 1230-1236

Kung, C.S.J., Johnston, D.W., Shields, M.A., 2018. Mental health and the response to financial incentives: Evidence from a survey incentives experiment. Journal of Health Economics 62, 84-94

Le, H.T., Nguyen, H.T., 2018. The Impact of Maternal Mental Health Shocks on Child Health: Estimates from Fixed Effects Instrumental Variables Models for two Cohorts of Australian Children. American Journal of Health Economics 4, 185-225

Lee, D.S., Lemieux, T., 2010. Regression Discontinuity designs in economics. Journal of Economic Literature 48, 281-355

Liebman, J.B., Luttmer, E.F.P., 2015. Would People Behave Differently If They Better Understood Social Security? Evidence from a Field Experiment. American Economic Journal: Economic Policy 7, 275-99

Madrian, B.C., Shea, D.F., 2001. The Power of Suggestion: Inertia in 401(k) Participation and Savings Behavior. The Quarterly Journal of Economics 116, 1149-1187

Mani, A., Mullainathan, S., Shafir, E., Zhao, J., 2013. Poverty Impedes Cognitive Function. Science 341, 976

Meyer, B.D., Mok, W.K.C., Sullivan, J.X., 2015. Household Surveys in Crisis. Journal of Economic Perspectives 29, 199-226

Moffitt, R., 1983. An economic model of welfare stigma. American economic review 73, 1023-1035

Mullainathan, S., Bertrand, M., Luttmer, E.F.P., 2000. Network Effects and Welfare Cultures. The Quarterly Journal of Economics 115, 1019-1055

Mund, M., Louwen, F., Klingelhoefer, D., Gerber, A., 2013. Smoking and Pregnancy — A Review on the First Major Environmental Risk Factor of the Unborn. International Journal of Environmental Research and Public Health 10

Nguyen, H.T., Connelly, L., Le, H.T., Mitrou, F., Taylor, C., Zubrick, S., 2019. Sources of Ethnicity Differences in Non-Cognitive Development in Children and Adolescents. Life Course Centre Working Paper Series, 2019-21. Institute for Social Science Research, The University of Queensland

O'Donoghue, T., Rabin, M., 1999. Doing It Now or Later. American Economic Review 89, 103-124

Rossin-Slater, M., 2013. WIC in your neighborhood: New evidence on the impacts of geographic access to clinics. Journal of Public Economics 102, 51-69

Saez, E., 2009. Details Matter: The Impact of Presentation and Information on the Take-Up of Financial Incentives for Retirement Saving. American Economic Journal: Economic Policy 1, 204-28

Tempelman, C., Houkes-Hommes, A., 2016. What Stops Dutch Households from Taking Up Much Needed Benefits? Review of Income and Wealth 62, 685-705

Thaler, R.H., Sunstein, C.R., 2008. Nudge: Improving Decisions About Health, Wealth, and Happiness. Yale University Press, New Haven, CT, US.

Van Mechelen, N., Janssens, J., 2017. Who is to blame? An overview of the factors contributing to the non-take-up of social rights. Herman Deleeck Centre for Social Policy Working Paper No. 17 / 08

Wooldridge, J.M., 2010. Econometric Analysis of Cross Section and Panel Data. MIT Press, Cambridge, Mass.