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Zhong J., Luo R., Sylvia S., Dill S.E., Medina A., Rozelle R. Passive versus Active Service Delivery: Comparing the Effects of Two Parenting Interventions on Early Cognitive Development in Rural China. Abstract

We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a home-based intervention conducted in the same region, using the same parenting curriculum and public service system. We find that the center-based intervention significantly improved children’s cognitive skills by 0.11 standard deviations, accompanied by increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention, however, was approximately half that of the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of compliance. Although children with lower levels of initial skills at baseline benefited the most from the center-based intervention, they were less likely to participate in the program.

Sylvia S., Yi H., Xue H., Liu G. Managerial Authority and Public Service Quality: Evidence from Civil Service and Fixed-term Physician Supply of Primary Care. Abstract

Reforms in a number of countries have sought to improve public health care delivery by giving facility managers greater autonomy over personnel decisions outside of rigid civil service rules. Yet, it remains unclear whether quality deficits are due to civil-service employment contracts directly or to institutional features of the public sector more generally. We use data from interactions with unannounced standardized patients to compare the quality of care provided by civil service physicians with physicians hired by the same public facilities on fixed-term contracts in China. We present four key findings. First, physicians employed on fixed-term contracts substantially outperform civil service physicians despite having fewer qualifications. Second, differences in performance appear attributable to both stronger career and wage incentives arising from contract status. Third, despite the potential for stronger incentives to generate clinic revenue, we find no evidence that fixed-term physicians increase patient out-of-pocket costs or unnecessary treatments relative to civil service physicians. Finally, effects of contract status vary with physician prosocial preferences: fixed-term contracts have a larger effect on effort among the prosocial but negate the effect of prosocial preferences on reductions unnecessary drug prescriptions.

Sylvia S., Ma X., Shi Y., Rozelle S., Lawell. C.-Y. Ordeal Mechanisms, Information, and the Cost-effectiveness of Subsidies: Evidence from Subsidized Eyeglasses in Rural ChinaAbstract

The cost-effectiveness of policies providing subsidized goods is often compromised by limited use of the goods provided. Through a randomized trial, we test two approaches to improve the cost-effectiveness of a program distributing free eyeglasses to myopic children in rural China. Requiring recipients to undergo an ordeal better targeted eyeglasses to those who used them without reducing usage relative to free delivery. An information campaign increased use when eyeglasses were freely delivered but not under an ordeal. Free delivery plus information was determined to be the most socially cost-effective approach and obtained the highest rate of eyeglass use.

Loyalka P., Manni M., Qu Y., Sylvia S.. Absolute versus Comparative Advantage: Consequences for Gender Gaps in STEM and College Access, Submitted. Abstract

We examine the impact of the competitive “STEM track choice”—a defining institutional feature of a number of national education systems—on gender gaps in STEM majors and college access. Many national education systems require high school students to make a largely irreversible, competitive choice between STEM and non-STEM tracks. This choice determines whether students will compete with STEM or non-STEM track students for college entrance. Using two datasets from China, we show that differences in how girls and boys make this choice are important reasons that girls select out of STEM, independent of gender differences in preference or ability. Specifically, we find that girls are more likely to choose their track by comparing their own STEM and non-STEM abilities (their “comparative advantage”) whereas boys are more likely to base their decision on how their STEM ability compares to others (their “absolute advantage”). Because girls often score higher in non-STEM subjects, looking at comparative advantage leads girls who would be competitive in the STEM track to nevertheless choose the non-STEM track. We further show that choosing the non-STEM track decreases the chance that these girls access college and elite colleges. Thus, the STEM track choice not only leads to gender imbalance in the number of STEM graduates but also to gender inequality in college access.