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Does Increased Access Increase Equality Gender and Child Health Investments in India

Emily OsterUniversity of Chicago and NBER

Draft: April 15 2008


Increases in access to social services are often thought to decrease inequality in the level of these services between advantaged and disadvantaged groups. This is an issue in the developing world, where policy-makers often argue that increasing the level of health care, for example, will decrease gender inequality. However, increases in access to services often have empirically ambiguous effects on inequality, increasing it in some cases and decreasing it in others. This paper argues that this is not surprising, and simple economic theory suggests that we should expect a non-monotonic relationship between access and inequality. At low levels of access to investments, there is no investment for either the advantaged or disadvantaged group, producing equality. Increases in access increase investment for the advantaged group first, generating inequality. Further increases in access increase investment in the disadvantaged group, decreasing inequality. I test the predictions of this theory using data on the availability of health camps (or distance to health centers) and gender differences in vaccinations in India. I find strong support for a non-monotonic relationship between access and gender equality.



It is often suggested that increasing overall access to social services – education or health, for example – will decrease inequality between advantaged and disadvantaged groups in these services. For example, public education was initially designed to provide training to those who could not afford private schooling, using universal access to provide opportunities to the lower classes. More recently, proponents of universal preschool or pre-kindergarten argue that this will increase relative outcomes for lower socioeconomic status groups (O’Connell, 2005; Sawhill, 1999). This link between higher access and lower inequality is salient even when lower inequality is not the primary goal of increasing access. Universal access to Medicare among the elderly is largely motivated by concerns

Gary Becker, Kerwin Charles, Steve Cicala, Amy Finkelstein, Andrew Francis, Jon Guryan, Matthew Gentzkow, Lawrence Katz, Michael Kremer, Steven Levitt, Kevin Murphy, Jesse Shapiro, Andrei Shleifer, Rebecca Thornton, three anonymous referees and participants in seminars at Harvard University, the University of Chicago, Stanford University, Princeton University and the NBER provided helpful comments. I am grateful for funding from the Belfer Center, Kennedy School of Government. Laura Cervantes provided outstanding research assistance.


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