This paper offers a review of recent literature regarding the take up of social programs in the U.S. and U.K. A few general conclusions are drawn: First, take up is enhanced by automatic or default enrollment and lowered by administrative barriers, although removing individual barriers does not necessarily have much effect, suggesting that one must address the whole bundle. Second, although it may be impossible to devise a definitive test of the stigma hypothesis', other, more concrete types of transactions costs are probably a good deal more important. Third, although people generally have means-tested programs in the United States in mind when they discuss take up, low take up is also a problem in many non means-tested social insurance programs and in other countries. Historically, economists have paid little attention to rules about eligibility, and virtually no attention to how these rules are enforced or made known to eligibles. Hence, the marginal return to new data about these features of programs is likely to be high in terms of understanding take up. In an era of social experiments, it might also prove useful to consider experimental manipulations of factors thought to influence take up.

We estimate the effect of maternal education on birth outcomes using data from the Vital Statistics Natality files for 1970 to 1999. We also assess the importance of four potential channels through which maternal education may improve birth outcomes: use of prenatal care, smoking behavior, marriage, and fertility. In an effort to account for unobserved characteristics of women that could induce spurious correlation, we pursue two distinct empirical strategies. First, we construct panel data by linking women in different years of the Vital Statistics records and examine the effects of changes in education on changes in birth outcomes. Second, we have compiled a new data set on openings of two and four year colleges between 1940 and 1990. We use data about the availability of colleges in the woman's county in her 17th year as an instrument for maternal education Our findings using the two approaches are similar. Higher maternal education improves infant health, as measured by birthweight and gestational age. It also increases the probability that a new mother is married, reduces parity, increases use of prenatal care, and reduces smoking, suggesting that these are important pathways for the ultimate effect on health.

We use data from the third National Health and Nutrition Examination Survey to examine the prevalence and determinants of poor nutritional outcomes among American youths. One strength of our analysis is that we focus on an array of nutritional outcomes, and we find in fact that the determinants of these outcomes vary considerably form outcome to outcome. We interpret our results using a model in which investments in health capital are affected by both resource constraints and a human capital production function that summarizes available nutrition information. We find that although many youths suffer from nutrient deficiencies, these conditions are not generally sensitive to measures of resource constraints, and hence are unlikely to be due solely to a shortage of food. Conversely, we find that our proxies for information matter. Our results suggest that broad-based policies designed to alter the composition of the diet may hold the greatest promise for addressing the nutritional problems of American youths.

Many observers have blamed HMOs for increasing financial pressures on private hospitals and causing them to cut back on the provision of charity care. We examine this issue using data on all hospital discharges in California between 1988 and 1996. We find that public hospitals in counties with higher HMO penetration do take on a larger share of the county's charity caseload. However, these public hospitals also take on larger shares of most other types of patients. At the hospital level, we find little evidence that either for-profit or non-profit private hospitals respond to HMO penetration by turning away uninsured and Medicaid patients. On the contrary, in the for-profit sector higher HMO penetration is linked to reductions in the share of privately insured patients in the caseload, and corresponding increases in the share of Medicare patients and Medicaid births. Since HMO penetration reduces the price paid by privately insured patients they may be less attractive to for-profit hospitals relative to the publicly insured.

We use data from the National Health Interview Surveys to measure the effects of the growth of Medicaid managed care on children. We examine both the probability that individual children were Medicaid-covered and their utilization of care. We find that managed care penetration has significant effects on the composition of the Medicaid caseload. Poor white and Hispanic children are more likely to be enrolled in Medicaid where Medicaid managed care organizations are more prevalent, whereas black children are less likely to be enrolled. Also, toddlers are less likely to be enrolled than school age children. These lower enrollment rates are linked to increases in the numbers of black children and toddlers who go without any doctor visits in a year. Our results are consistent with cream-skimming by Medicaid managed care organizations along the lines of race and age.

Little is known about the mechanisms underlying the transfer of economic status between generations. This paper addresses the question of whether inter-generational correlations in health contribute to the perpetuation of economic status. We examine inter-generational correlations in birth weight, a key indicator of the health of newborns that we link to future educational attainment and earnings using a unique data set based on California births from 1960s to the present. We use names and birth dates to link the records of mothers and children. We also identify mothers who are siblings. We show that there is a strong intergenerational correlation in the birth weight of mothers and children, but that a measure of household income at the time of the mother's birth is also predictive of low birth weight and that there is an interaction between maternal low birth weight and poverty in the production of low birth weight. Together these findings suggest that intergenerational correlations in health could play a role in the intergenerational transmission of income. Parent's income affects child health, and health at birth affects future income.

Critics of Head Start contend that many programs spend too much money on programs extraneous to education. On the other hand, Head Start advocates argue that severely disadvantaged children need a broad range of services. Given the available evidence, it has been impossible to assess the validity of these claims. In this study, we match detailed administrative data with data on child outcomes from the National Longitudinal Survey of Youth 1979, including test scores, behavior problems, and grade repetition. We find that former Head Start children have higher reading scores and are less likely to have been retained in grade where Head Start spending was higher. Holding per capita expenditures constant, children in programs that devoted higher shares of their budgets to education and health have fewer behavior problems and are less likely to have been retained in grade. However, when we examine specific educational inputs holding per capita expenditures constant, only pupil/teacher ratios matter.

We examine the impact of air pollution on infant death in California over the 1990s. Our work offers several innovations: First, many previous studies examine populations subject to far greater levels of pollution. In contrast, the experience of California in the 1990s is clearly relevant to current debates over the regulation of pollution. Second, many studies examine a few routinely monitored pollutants in isolation, generally because of data limitations. We examine four criteria' pollutants in a common framework. Third, we develop an identification strategy based on within zip code variation in pollution levels that controls for potentially important unobserved characteristics of high pollution areas. Fourth, we use rich individual-level data to investigate effects of pollution on infant mortality, fetal deaths, low birth weight and prematurity in a common framework. We find that the reductions in carbon monoxide (CO) and particulates (PM10) over the 1990s in California saved over 1,000 infant lives. However, we find little consistent evidence of pollution effects on fetal deaths, low birth weight or short gestation.

Evaluations of changes to the Medicaid program have focused on increases in the generosity of income cutoffs for eligibility. Previous research shows that despite dramatic increases in the number of births paid for by Medicaid, many eligible women are still getting inadequate prenatal care. States have addressed this problem by adopting administrative measures designed to simplify the Medicaid application process and encourage the use of prenatal care. At the same time, recent declines in welfare caseloads may have caused many women to lose their Medicaid coverage by effectively increasing administrative barriers to obtaining care. We examine the effects of changes in income eligibility, administrative reforms, and welfare caseloads on the use of prenatal care and infant health using data from birth certificates covering all U.S. births between 1990 and 1996. We find that increases in income cutoffs were associated with increased use of prenatal care among whites, while decreases in welfare caseloads were associated with reduced use of prenatal care, especially among blacks. Reduced form estimates suggest that changes in income cutoffs were associated with a reduced probability of fetal death among blacks and disadvantaged whites. None of the administrative reforms we consider had consistently positive effects. These results suggest that the administrative reforms undertaken to date have been insufficient to break the close link between participation in welfare and access to prenatal care under the Medicaid program.

This study focuses on network effects' in the utilization of publicly funded prenatal care using Vital Statistics data from California for 1989 to 2000. Networks are defined using 5-digit zipcodes and a woman's racial or ethnic group. Like others, we find evidence that the use of public programs is highly correlated within groups defined using race/ethnicity and neighborhoods. These correlations persist even when we control for many unobserved characteristics by including zipcode-year fixed effects, and when we focus on the interaction between own group behavior and measures of the potential for contacts with other members of the group ( contact availability'). However, the richness of our data allows us to go further and to conduct several tests of one hypothesis about networks: That the estimated effects represent information sharing within groups. The results cast doubt on the idea that the observed correlations can be interpreted as evidence of information sharing, and point instead to differences in the behavior of the institutions serving different groups of low-income women as the primary explanation for group-level differences in the take-up of this important public program.