Abstract
Health care providers—nurses and physicians—are central in shaping the production of patient health. We study the impact of provider effectiveness on long-run patient health and socioeconomic outcomes. We do so in a novel setting, focusing on infants treated in a 1960s universal preventive care program in the Danish capital Copenhagen. We combine data from handwritten nurse records (containing the nurse name, nurse treatment decisions, and nurse registrations on breastfeeding and first year infant development) and administrative data on long-run child and mother outcomes. For identification, we exploit arbitrary allocation of children to nurses within sections of the city and year of birth. We start by documenting variation in nurse effectiveness, which we measure with respect to one core objective of the preventive care program: the promotion of breastfeeding. Nurses, who are effective at increasing early breastfeeding among their assigned families (at one month after birth), increase breastfeeding duration and healthy weight development during the first year of a child's life. In the longer run, we find that effective nurses increase the educational attainment of children (albeit effects are very small). What do good nurses do? In preliminary analyses we do not detect differences in specific nurse treatment decisions that we can study and we have no information on nurse characteristics. We further explore whether impacts on focal children run through mothers. In our analyses of mother outcomes, we find little impacts of nurse effectiveness, but we again find that effective nurses increase breastfeeding behaviors (not only for focal children but also later-born children). Our findings taken together for now suggest that effective nurses—maybe due to better personal interactions in the family home—impact some maternal child investment decisions, in particular breastfeeding decisions. In our setting with poor counterfactual modes of infant feeding, these changes appear to be the main driver of education impacts of effective nurses that we find.
Local Organizer: Giovanni Angelini