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Journal of Public Economics 93 (2009) 246263
Born on the rst of July: An (un)natural experiment in birth timing
Joshua S. Gans a,, Andrew Leigh b
Melbourne Business School, University of Melbourne, Australia Research School of Social Sciences, Australian National University, Australia
It is well understood that government policies can distort behavior. But what is less often recognized is that the anticipated introduction of a policy can introduce its own distortions. We study one such introduction effect, using evidence from a unique policy change in Australia. In 2004, the Australian government announced that children born on or after July 1, 2004 would receive a $3000 Baby Bonus. Although the policy was only announced seven weeks before its introduction, parents appear to have behaved strategically in order to receive the benet, with the number of births dipping sharply before the policy commenced. On July 1, 2004, more Australian children were born than on any other single date in the past thirty years. We estimate that over 1000 births were moved so as to ensure that their parents were eligible for the Baby Bonus, with about one quarter being moved by more than one week. Most of the effect was due to changes in the timing of induction and cesarean section procedures. We nd evidence to suggest that babies who were shifted into the eligibility period were more likely to be of high birth weight. Two years later, on July 1, 2006, the Baby Bonus was increased, and we nd that this again caused births to be moved from June to July. These birth timing events represent an opportunity for health researchers to study the impact of planned birthdays and hospital management issues. 2008 Elsevier B.V. All rights reserved.
Article history: Received 6 June 2007 Received in revised form 3 June 2008 Accepted 21 July 2008 Available online 24 July 2008 JEL classication: H31 J13 Keywords: Introduction effect Timing of births Policy distortion
TIM LESTER: Minister, with the benet of hindsight, would it have been better to have announced and introduced this policy on the same day? KAY PATTERSON: This policy is a bonus to families. TIM LESTER: That doesn't answer my question, though, with respect, Minister. Would it have been better to have announced and introduced this policy at the same time? KAY PATTERSON: I believe this is a fantastic policy for mothers, they're going to get $3000
In part, this paper uses condentialised unit record le data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. The HILDA Project was initiated and is funded by the Australian Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) and is managed by the Melbourne Institute of Applied Economic and Social Research (MIAESR). The ndings and views reported in this paper, however, are those of the authors and should not be attributed to either FaHCSIA or the MIAESR. We are grateful to Heather Booth, Bruce Chapman, Paul Frijters, Joe Hirschberg, Susanne Schmidt, Scott Stern, Justin Wolfers, seminar participants at Columbia University and two anonymous referees for valuable comments on earlier drafts. This paper uses more recent births data than a previous version, though this has only a slight impact on the results. Corresponding author. E-mail addresses: J.Gans@unimelb.edu.au (J.S. Gans), andrew.leigh@anu.edu.au (A. Leigh). URL's: http://www.mbs.edu/jgans (J.S. Gans), http://econrsss.anu.edu.au/~aleigh/ (A. Leigh). 0047-2727/$ see front matter 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.jpubeco.2008.07.004
J.S. Gans, A. Leigh / Journal of Public Economics 93 (2009) 246263
TIM LESTER: Minister, that still doesn't answer my question with respect. Would it have been better to have announced and introduced this policy at the same time? KAY PATTERSON: Well if I thought that mothers would put their babies at risk, but I don't believe mothers would put them at risk.1 1. Introduction Economists have long been concerned that seemingly subtle issues of policy announcements and the timing of policy shifts can have dramatic short-term effects on individual behavior. Consider a situation where a government announces a new tax benet or a subsidy that will be introduced at some later date. It can be expected that to the extent that they have some discretion as to the timing of their decisions individuals will shift their actions around the policy introduction date to take advantage of a benet or avoid a detriment. Just as the existence of government policies can distort behavior, so too policy changes can further distort individuals' decisions. Such an effect might be termed an introduction effect. Frequently, the announcement that a new tax or subsidy will take effect upon a certain date leads to news reports of individuals or rms rearranging their affairs so as to take advantage of the policy change. However, it is rare to nd an opportunity in which the effect of such policy changes can be quantitatively estimated.2 In this paper, we identify a policy change that created the potential for an introduction effect. On May 11, 2004, the Australian government announced that it would give a $3000 Maternity Payment, commonly referred to as a Baby Bonus to each family of a newborn child.3 For our purposes, the important feature of the Baby Bonus policy was that it was to only apply for babies born on or after July 1, 2004. Thus, a household with a child born at 11:59 pm on June 30, 2004, would receive no payment while one with a child born at 12:01 am on July 1, 2004, and thereafter would receive $3000.4 This creates the potential for an introduction effect especially given the lag between the policy announcement and the introduction date. The seven week lag between the policy announcement and its introduction would not have an impact on the number of pregnancies as those affected by the introduction were already in the process; the third trimester, in fact.5 However, it could have an impact on either (i) discretionary and planned birth timing decisions (such as inductions and elective cesarians) and/or (ii) the reporting of birthdays. In each case, the impact on reported birth timing would be jointly determined by the parents and doctor involved.6 We obtained daily data on all recorded births in Australia from 1975 to 2004. Even without any statistical analysis, the effect appears dramatic. On June 30, 2004 (a Wednesday), 500 babies were registered as having been born, a birthrate at the 11th percentile of the births distribution over the entire period 19752004 (and the 1st percentile of the births distribution on weekdays).7 On July 1, 2004, 1005 babies were born. This was the highest number of births recorded throughout the 10,958-day period 19752004. The fth-highest number of births on a single day was July 2, 2004 with 928. With a exible functional form, allowing for separate day-of-year, day-of-week and year effects, we nd that the introduction of the Baby Bonus was associated with a substantial increase in the birth rate. Our results are highly statistically signicant, as well as being economically signicant. Over the window covering 28 days before and 28 days after the policy was introduced, we estimate that over 1000 births were moved into the eligibility range. Data from induction and cesarean section procedures indicate that these accounted for most of the shift. Analyzing a subsample of birth records, we nd that babies born in early-July were signicantly heavier than those born in late-June, which would be consistent with parents delaying births to obtain the payment. All of this provides an indication that shifting was, in fact, real and not a result of reporting issues or fraud. As well as providing an experiment that identies an introduction effect, our result here is also a contribution to our understanding of the short-run drivers of the timing of births. Chandra et al. (2004) demonstrated that birth numbers fall on weekends as compared with weekdays, and that this effect has grown over time. They also found that less risky births were more likely to be moved. A very similar trend away from weekend births has also occurred in Australia (Gans and Leigh, 2007). Indeed, as we discuss below, it is important that we take account of day-of-week effects when estimating the true magnitude of the introduction effect. In relation to the impact of government policies, Dickert-Conlin and Chandra (1999) demonstrated that tax incentives in the US caused births to be shifted from the rst week of January each year to the last week of December. They estimated that increasing the tax benet of having a child by $500 raised the probability of an end of December birth by 26.9%.8 Our paper offers a distinct insight into birth timing and incentives. First, the government policy created an incentive to delay the birth as opposed to bringing it forward. As babies are often born prematurely, there is intrinsically less control in this decision than a decision for an earlier birth.
From the 7:30 Report (ABC Television, July 1, 2004); Kay Patterson was the Minister for Health in the Australian Government. Exceptions to this are Kopczuk and Slemrod (2003), Gans and Leigh (2006a), and Eliason and Ohlsson (2008), who nd that changes in the estate tax rate in the US, Australia, and Sweden had an impact on the number of reported deaths. 3 All gures are in Australian dollars. In 2004, A$1 = US$0.75 (approx). 4 Precisely 12:00 am was apparently a grey area (Sunday Telegraph, June 27, 2004, p.5). 5 Including the third child of the rst author; eventually born on July 25, 2004. 6 In the case of home births, it would be the mid-wife. However, we do not separately identify these in our data. 7 There were some births reported close to midnight: ABC Radio (July 1, 2004) reported a birth at 11:53pm. 8 Milligan (2005) studied the introduction of a baby bonus (or Allowance for Newborn Children) in Quebec, Canada. However, in that case, the policy commenced on the day of its announcement, so there was no potential for an introduction effect. In 2006, the German and Singaporean governments both announced that they planned to offer payments to new parents, potentially creating the opportunity for further investigation of introduction effects.
Second, the US tax incentive exists in every year, allowing hospitals to allocate additional resources to take account of it. The introduction of the Baby Bonus in Australia had a one-off effect, and so likely created unplanned resource utilization problems. In this situation, one would expect hospitals and doctors to have been more constrained in their ability to respond to parental requests to adjust the timing of the birth so that they were eligible for the Baby Bonus. Our observed impacts are, therefore, informative as to the degree of power that patients have over the timing of births.9 While the Australian Baby Bonus represents a clean experiment in analyzing the introduction effect, there is some question whether what mattered was an increase in real incentives provided by the Baby Bonus or a reaction to a clearer and more transparent set of incentives. As we describe below, the Baby Bonus replaced an earlier child birth incentive. In contrast to the new Baby Bonus, however, this earlier benet was income-related and so varied considerably depending on individual circumstance. Also, it was a benet realized with some considerable delay whereas the Baby Bonus cash payment was immediate.10 Given its relative complexity, it is unclear whether the earlier policy was recognized as an incentive at all.11 The paper proceeds as follows. In the next section, we describe in more detail the Australian Baby Bonus and its predecessor. Section 3 estimates the total number of births that were moved. Section 4 decomposes the effect across birth procedures. Section 5 analyzes the characteristics of those babies that were born, and their parents. Section 6 presents the results of a subsequent increase in the Baby Bonus, which occurred in 2006. The nal section concludes. 2. The Australian Baby Bonus From July 1, 2004, the Baby Bonus operated very simply. If a family gave birth to a child after this date, they automatically received a cash payment of $3000. The payment was untaxed, and was given to all parents regardless of income. For the median household, this amount was worth 5.4% of annual disposable income (equivalent to 2.8 weeks' post-tax income).12 The payment was per baby and so for the multiple births the payment was $6000 for twins or $9000 for triplets. The policy was announced as part of the 20042005 Budget. It was not anticipated and can, therefore, be taken as essentially unknown prior to May 11, 2004.13 The stated goal of the policy was to provide further help at the crucial period around the birth of a child (Australian Treasury, 2004, 33) (though with Australian voters due to go to the polls in late-2004, purely political motives cannot be ruled out; particularly as the Opposition Leader had proposed a similar policy in March 2004). There was considerable publicity about the introduction of the policy when it was announced, and further coverage in June 2004.14 This included a media discussion as to whether the policy might encourage teenage pregnancy and suggestions that teenagers might in future be excluded from receiving the bonus.15 The Baby Bonus we described here replaced a previous policy, which operated as a refundable tax offset.16 That policy worked as follows: for each baby born between July 1, 2001 and June 30, 2004, the primary carer of the child (that is, the parent staying at home) was eligible to claim for a bonus.17 The bonus depended on the income the primary carer earned in the tax year (in Australia from July to June) that the child was born. If the primary carer's income was $25,000 or less, the taxpayer would receive $500/yr.18 If the income exceeded this amount, then the taxpayer would only receive a payment if their income fell. In this case, the benet could potentially be quite large. The size of the payment depended on the taxpayer's income level prior to having a baby (Inc0), their average tax rate in that year (0), and their income level in year t (where t 5). The yearly bonus in year t was then calculated as follows:19   Inct min 0 Inc0 ; D12; 500 Yearly Bonust 1 5 Inc0
9 As Chandra et al. (2004) noted, it is unclear whether the weekend/public holiday decline is driven by doctor/hospital or patient preferences. This is not the case for changes in timing based on the Baby Bonus. 10 The rst author received his $3000 payment via electronic transfer in 5 weeks. 11 Again the rst author's experience is instructive here. Prior to the introduction of the new Baby Bonus, his household was blissfully unaware of any nancial benet to having a child. 12 Authors' calculations, based on the Household, Income and Labour Dynamics in Australia survey (HILDA). 13 A media search in the weeks prior to the budget reveals that the government made it known to some journalists in early May that the Baby Bonus would probably be revamped in the budget. However, details were not provided at the time, so the changes remained speculative. 14 For example, much coverage was given to the Treasurer's suggestion to the media on May 11, 2004 that Australian parents should have one for mom, one for dad, and one for the country.. A search of the Factiva database for the terms Baby Bonus and Maternity Payment returns 411 articles published in Australian newspapers during May and June 2004. 15 On the furor over teens, see for example Arndt (2004), Grattan and Nguyen (2004). On 1 January 2007, the Australian government changed the rules so that parents aged 17 years or under would receive the Baby Bonus in 13 fortnightly installments, unless special circumstances existed to warrant the payment of a lump sum. On 15 May 2008, the government announced that all families would receive the Baby Bonus in 13 fortnightly installments (commencing 1 July 2008), and that eligibility would be restricted to families with adjusted taxable income equivalent to $150,000 or less a year (commencing 1 January 2009). 16 The new Baby Bonus also replaced the Maternity Allowance, a means-tested payment to those families receiving Family Tax Benet A. At the time of the change, the Maternity Allowance was worth $842.64 per child for eligible families. 17 Both the old Baby Bonus and the new Baby Bonus were also available to adoptive parents. 18 The rst year amount would be reduced to take into account the birth date of the child. 19 There were adjustments to this based on part-years for the beginning and end of the rst 5 years. The amount was payable following the lodgment of an income tax return with a minimum time to refund of 3 to 15 months depending upon when in the year the child was born.
Thus, carers earning high salaries (in particular, those paying a lot of tax) just prior to having a baby and then earning very little thereafter would receive the maximum payment of $2500/yr.20 The new Baby Bonus announced in 2004 was anticipated to be considerably more expensive to the government than the previous scheme. In its last year of operation (tax year 200304), expenditures on the old child payment were $150 million (ATO, 2004, 368).21 In its rst year of operation, the new Baby Bonus was expected to cost the federal government $741 million (Australian Treasury, 2004, 37).22 Nonetheless, there may exist households for which there were incentives to time births prior to July 1, 2004 rather than on or after that date (as they would receive potentially 5 years of benets from the old policy). For other households, the difference between the old payment and the new payment may have been less than $3000. To the extent that this is the case, any introduction effect from the new Baby Bonus will understate the impact of a $3000 nancial incentive on birth timing.23 3. Baby Bump? With changes in medical technology and practice, doctors and patients have increased discretion over the timing of births. At dates prior to when a natural, vaginal delivery of a child would occur, births can be induced or brought about by cesarean section. The safe window of discretion is potentially greater than three weeks. For example, guidelines dened by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists dene pre-term births as those that occur up to the end of the 37th week of pregnancy, term births as those that occur from the 38th to the 42nd week, and post-term births as those that occur on or after the rst day of the 43rd week of pregnancy (AAP, ACOG, 2002; see also WHO, 1992; Engle, 2006). While medical and health concerns play an important role in any exercise in discretion over birth timing, there is evidence that non-medical issues also play a role. There is a long-term trend towards fewer births on weekends (Chandra et al., 2004; Gans and Leigh, 2007) and even reductions in birth rates on auspicious days (Lo, 2003; Gans and Leigh, 2006b, in press) and during the week of the annual conference of professional obstetrics associations (Gans et al., 2007). In addition, in Australia and the United States, there is a mini-baby boom each year 710 days prior to Christmas Day perhaps reective of joint preferences of doctors and patients not to have births at that time (Gans et al., 2007). Consequently, it is plausible that direct nancial incentives may affect birth timing. The introduction of the Baby Bonus gave parents an incentive not to schedule births prior to July 1. As a consequence, it is plausible that some births that would have otherwise been expected to occur prior to that date did not. Moreover, it is likely that the incentives and the degree of discretion to change scheduled procedures in response to the Baby Bonus introduction effect would be stronger closer to July 1, 2004. Consequently, this will have an impact on the mix of birth delivery mechanisms observed prior and after that date. To test the impact of the Baby Bonus on recorded births, we use daily data on the number of Australian births. There are two main sources of births data gures collected by state and territory births registries, compiled by the Australian Bureau of Statistics (ABS); and data collected from hospitals, compiled by the Australian Institute of Health and Welfare (AIHW). Each source has its limitations: unregistered births do not appear in the ABS data, while home births do not appear in the AIHW data. By using both data sources, we hope to circumvent the problems that would arise from only analyzing one or the other. Since the ABS births data cover a longer time span, our central analysis uses these data. They include all recorded births from 19752004. While the birth rate in Australia has declined over this period, the number of births has remained relatively constant (there were 232,682 births in 1975, and 245,143 births in 2004). We therefore opt to focus on the number of births, rather than on the birth rate. This has the added advantage that we do not introduce noise into our series through mis-measurement of the total population, which is only available on a monthly basis. Fig. 1 focuses on the period from June 3 to July 28, being the last 28 days prior to the policy change, and the rst 28 days from the policy change onwards. In Panel A, we simply show the raw data. We observe a trough in late-June, and a peak in early-July. An intuitive way of looking at the data is simply to calculate the number of births in the last seven days of June and the rst seven days of July (this effectively averages out the day of week effect). In 2004, 3978 babies were born in the last week of June, and 5367 in the rst week of July. As the data from Panel A of Fig. 1 indicate, there is a strong weekly cycle in the number of babies born. From 19752004, an average of 733 children were born on weekdays and 519 on weekends. This makes it harder to discern the impact of the introduction of the Baby Bonus on July 1, 2004 (which was a Thursday).
20 As Leigh and Wolfers (2002) note, the old Baby Bonus had potentially undesirable incentive properties including: (i) incentives for women to work long hours during pregnancy; (ii) incentives to concentrate all births in a 5 or so year window; and (iii) strong disincentives to return to work within 5 years of having a child. These were not features of the new Baby Bonus. 21 Since payments under the old birth payment can continue for up to 5 years after the birth of the child, the old program continued until tax year 2008-09. This makes it problematic to use tax ofce data to calculate total payments under the new Baby Bonus, since the tax ofce does not separately tabulate the cost of the two programs. 22 Of course, any introduction effect would have increased the cost of the new Baby Bonus, and reduced the cost of the old Baby Bonus. We know of no evidence to suggest that the introduction effect was taken into account in the Australian Treasury's projections of the rst year cost of the Baby Bonus. 23 Related to this issue is Finkelstein (2007), who demonstrates that the salience of tax payments rather than just their magnitude impacts on behavior in the acceptance of toll payment increases.
Fig. 1. Introduction Effect in 2004. Panel A shows daily birth counts. Panel B shows births relative to expected, accounting for year, day of week, day of year, and public holidays. In panel B, shading shows days of unusually low births in June and unusually high births in July.
To purge the day of the week effect, we therefore adjust the series for day of week, day of year, holiday, and year effects. We do this by estimating the following regression, using all data except June and July 2004: Birthsi IiYear IiDay of
IiDay of
IiPublic Holiday ei
In Eq. (1), the dependent variable is the number of babies born on day i. This is expressed as a function of indicators for the year interacted with the day of the week (e.g. allowing for a separate effect for Thursdays in 2004), for the day of the year (e.g. allowing for a separate effect on July 1), and an indicator for public holidays (which do not always fall on the same day of the week or day of the year).24 For simplicity, parameters are omitted. 1 We then use this regression to make an out-of-sample prediction of the daily birth count (Births) for June and July 2004. Panel B shows the difference between this predicted birth count and the observed birth count (BirthsBirths). In the month before the policy change, births were well below the level that would have been expected, while in the month afterwards, births were well above the expected level. To formally test the effect of the Baby Bonus on the number of births, we estimate the regressions: Birthsi IiBaby Bonus IiYear IiDay of
lnBirthsi IiBaby Bonus IiYear IiDay of
In Eqs. (2) and (3), the dependent variables are the daily birth count and the log of the daily birth count, respectively. The indicator variable IBaby Bonus denotes dates after which the Baby Bonus took effect. The other variables are as dened above. To see the effect of the Baby Bonus on the timing of births, we progressively widen the window of analysis. The rst column of Table 1 restricts the sample to the last 7 days of June and the rst 7 days of July, the second column to the last 14 days of June and the rst 14 days of July, and so on.25
24 We include all Australia-wide public holidays, plus the Queen's Birthday holiday, which is celebrated on the second Monday in June in all states and territories except Western Australia. 25 Widening the window has two purposes. First, it allows for births to have been moved by more than one week. Second, it accounts for the possibility that some parents may have attempted to delay their child's birth until July, but instead only moved the birth date from mid-June to late-June. Such unsuccessful moves would attenuate the estimates derived from focusing on a narrow window.
J.S. Gans, A. Leigh / Journal of Public Economics 93 (2009) 246263 Table 1 Birth rate effects Window (1) 7 days Panel A: Dependent variable is number of births Baby Bonus 210.507 [15.911] Observations 420 R-squared 0.97 Number of births moved 737 Panel B: Dependent variable is ln(number of births) Baby Bonus 0.300 [0.023] Observations 420 R-squared 0.97 Share of births moved 16% (2) 14 days 131.382 [11.626] 840 0.94 920 (3) 21 days 101.624 [9.579] 1260 0.94 1067 (4)
28 days 83.602 [8.386] 1680 0.93 1170
0.187 [0.017] 840 0.95 10%
0.147 [0.014] 1260 0.94 8%
0.123 [0.013] 1680 0.94 6%
Notes: Standard errors in brackets. signicant at 10%; signicant at 5%; signicant at 1%. Sample is daily births within the relevant window from 1975 2004. All specications include day of year, public holiday, and year day of week xed effects. Window denotes the number of days before and after the start of July. For example, the 7 day window covers the last seven days of June and the rst seven days of July. Number of births moved is W/2, where W is the number of days in the window. Share of births moved is exp( / 2) 1.
In Panel A of Table 1, we use the number of births as the dependent variable. Comparing the rst week of July and the last week of June (column 1), the Baby Bonus coefcient is 211. Comparing the rst fortnight of July and the last fortnight of June (column 2), the Baby Bonus coefcient is 131 births per day. With a three week window, the coefcient falls to 102, and to 84 with a four week window. In the last row of the panel, we estimate the number of births moved from June to July in each of these windows. As we note above, the policy can only have moved births, and cannot have affected conceptions nine months earlier (since it was only announced in May). Since a birth that is moved from June to July will reduce the number of June births by 1, and increase the number of July births by 1, we must calculate the total number of births moved by dividing the Baby Bonus coefcient by 2, and then multiplying it by the number of days in the window. Comparing the 28 days before and after the policy was introduced, we estimate that 1170 births were moved (28 83.602 / 2 = 1170). In Panel B of Table 1, we use the log of the number of births as the dependent variable, with similar results. Again, because a birth that is moved from June to July decreases pre-period births and increases post-period births, we divide the coefcient by two before converting from log points to percentage points. With a seven-day window, 16% of births were shifted into the eligibility period. With a 28-day window, we nd that 6% of the babies who would have been born in June were shifted to July. All the estimates in Table 1 are statistically signicant at the 1% level. The Baby Bonus effect was clearly concentrated in the week before and after the policy came into effect; as can be seen from the fact that the coefcients in Table 1 decline as we widen the window of analysis. But were some births moved a greater distance? To check this, we re-estimated Eqs. (2) and (3), replacing the indicator variable for the Baby Bonus with eight indicator variables, denoting the last four weeks of June and the rst four weeks of July. (So as to allow us to also include the year day of week xed effects, we widen the window to 56 days.26) The results from this exercise are shown in Table 2. Although the coefcients on the weeks immediately before and after the policy change are larger in magnitude than those further out, the shifting of births does not appear to be conned to this period. In either the levels specication (Panel A) or the logged specication (Panel B), all the June coefcients are negative and all the July coefcients are positive, and more than half are statistically signicant. Although the impact of the Baby Bonus is approximately symmetrical, there is some evidence that births began to fall from early-June onwards, and were higher than expected until mid-July. This is consistent with the incentives created by the sudden introduction effect: subject to our qualications regarding the previous policy, there existed many mothers who were due to give birth in June who could have beneted from delaying birth until July. But after July 1, there was no benet to further delay. In columns (2) to (4), we estimate the amount by which births fell in June, and rose in July. Since the policy was only announced in May, we expect the introduction effect to have an impact only on timing, and not on the aggregate number of births. Accordingly, the reduction in births in June should approximately match the increase in July. This does indeed appear to have been the case. We estimate that births fell by 1172 over the last 28 days of June, and rose by 1169 over the rst 28 days of July. About three-quarters of the reduction in births in June occurred in the last week, but one-quarter occurred in prior weeks. Specically, births were 45% lower in the weeks from 39 June and 1016 June. It is difcult to see any explanation for this other than that parents were attempting to move their child's birthdate into July in order to qualify for the new payment. Similarly, about three-quarters of the rise in births in July occurred in the rst week of July, but about one-quarter took place in the second, third or fourth week of July. From a policy perspective, this result is perhaps the most troubling. To the extent that the Baby Bonus effect involved changing the timing of induced births by one or two days, it is unlikely to have had a signicant impact on maternal or child health (aside, of
Our results are not greatly affected by the width of this window.
252 Table 2 Birth rate effectsmedium run
(2) Total births moved 14 days
Panel A: Dependent variable is number of births Before June 39, 2004 22.036 [11.908] June 1016, 2004 26.830 [11.908] June 1723, 2004 15.884 [11.905] June 2430, 2004 102.632 [11.905] After July 17, 2004 107.875 [11.905] July 814, 2004 36.373 [11.905] July 1521, 2004 15.353 [11.905] July 2228, 2004 7.427 [11.905] Observations 3360 R-squared 0.94 Panel B: Dependent variable is ln(number of births) Before June 39, 2004 0.035 [0.018] June 1016, 2004 0.046 [0.018] June 1723, 2004 0.022 [0.018] June 2430, 2004 0.158 [0.018] After July 17, 2004 0.142 [0.018] July 814, 2004 0.052 [0.018] July 1521, 2004 0.022 [0.018] July 2228, 2004 0.016 [0.018] Observations 3360 R-squared 0.94
1172 1017 830
1169 1117 829
Notes: Standard errors in brackets. signicant at 10%; signicant at 5%; signicant at 1%. All specications include day of year, public holiday, and year day of week xed effects. Sample covers May 6 to August 25 (56 days before and 56 days after July 1) from 19752004. Total births moved is the sum of the coefcients (in weeks 12, 13 or 14), multiplied by 7.
course, from any consequences from unexpected congestion issues in maternity wards). But the results in Table 2 are consistent with births being shifted by more than a few days. If all births that were shifted successfully qualied for the new payment, then our results suggest that the introduction of the Baby Bonus led 300 births to be shifted more than 7 days, and over 150 to be moved by more than 14 days. However, another possibility is that no large-scale shifting occurred, but that many parents tried and failed to qualify for the Baby Bonus.27 With aggregate data, we cannot separate these two hypotheses. Nonetheless, the fact that the disruption caused by the Baby Bonus was not conned to a few days around July 1 is cause for some concern, notwithstanding that the health consequences of shifting births are uncertain. In addition, our methodology cannot tell us precisely the cause of the shift. One possibility is that moving births from late June to the rst week of July may also have created congestion for that week. In that case, some births would have been pushed later into
27 At the extreme, it is possible that all the births that were shifted from 3-9 June were born in 10-16 June; that all the births that were shifted from 10-16 June were born in 17-23 June; and that all the births that were shifted from 17-23 June were born in 24-30 June.
Fig. 2. Comparing two sources of birth data. Note: dots show daily birth counts for 2004. The solid line is at x = y.
July. Such propagation may account for the signicant effects in the second week of July, and the positive (though statistically insignicant) effects in the third and fourth weeks of July. 4. Cesarean section and induction procedures In understanding the determinants of the shifting of births that occurred in JuneJuly, 2004, it is instructive to examine those births by procedure. One reason to do this is to identify whether mis-reporting played any role in the observed shifts.28 While the time periods over which births appear to have shifted works against this, by examining procedure shifts, we can explore this in more detail. In particular, if the mechanism for the shift was not discretionary procedure then it is likely that shifts for non-induced vaginal births would be at least as high as other procedures. To examine this, we now turn to our second source of births data hospital records compiled by the Australian Institute of Health and Welfare. We begin by comparing the total number of births from this data source with the total number of births from the ABS data. As McDonald (2005) has shown, the recent divergence between the two series raises concerns about their use for tracking aggregate trends in the birth rate. However, our study focuses on changes in the number of births within a short window, and for this purpose we nd little difference between the two data sources. Fig. 2 plots the two series against one another, demonstrating that they track one another closely. Regressing the raw ABS series on the raw AIHW series (using data for 2004) returns a beta coefcient of 0.9 (T = 48.1) and a constant of 27.5 (T = 2.0). This suggests that while the two series are very highly correlated, the hospital birth counts are on average 27 births per day higher than birth registrations data. In both the series, births on July 1, 2004 (the rst day on which the Baby Bonus took effect) are a clear outlier. While the AIHW series has the disadvantage that it is not available over a long time span, it has the advantage that it allows us to separate births into four delivery procedures. The procedures, and their corresponding share of 2004 births are: vaginal, not induced (50%); vaginal, induced (20%); cesarean section, induced (5%); and cesarean section, not induced (25%).
(The category cesarean section, induced refers to births in which labor was induced, and a cesarean section was subsequently performed generally due to complications in labor.) Fig. 3 decomposes births by birth procedure across June and July 2004, showing just the raw data (unadjusted for day-of-week effects). In Fig. 4, we adjust for day-of-week and public holiday effects (since our hospitals data do not span multiple years, we cannot also account for year and day-of-year effects). These two charts show that on July 1, births delivered by all four procedures increase, with the largest rise (in numerical terms) being for induced vaginal and non-induced cesarean section. Reported incidents
Further evidence against the mis-reporting hypothesis is the birth weight data presented in Section 5.
Fig. 3. Comparing birth procedures. Data cover JuneJuly 2004, and show daily birth counts.
Fig. 4. Comparing birth procedures. Regression-adjusted. Data cover JuneJuly 2004, and show births relative to expected, accounting for day of week and public holidays. Shading shows days of unusually low births in June and unusually high births in July.
conrm that the introduction of the Baby Bonus was the likely driver of this shift. In the nal week of June, 2004, there were numerous reports of elective cesarean procedures being fully booked for the rst week of July.29 To empirically estimate the effect of the introduction of the Baby Bonus on different types of birth procedures, we use a similar estimation strategy to that employed in Section 3. However, since we do not have data on births procedures over multiple
29 For example, Anderson (2004) quoting that for one hospital all of the planned spots were taken earlier than they normally would have been. ABC Television (July 1, 2004) reported one hospital where women in labor were resisting coming in and one obstetrician who had only seen one scheduled induction and elective caesarian, for the three last days of June and 14 on the rst two days of July. See also Massoud (2004), Scott (2004), and Wells (2004). As early as June 18, 2004, The Age reported on pressure for Health Minister to change the introduction date of the Baby Bonus and bring it forward following reports that 10% of mothers had asked to postpone planned cesareans.
J.S. Gans, A. Leigh / Journal of Public Economics 93 (2009) 246263 Table 3 Baby Bonus effects for different birth procedures Window (1) 7 days Panel A: Vaginal, not induced Baby Bonus Observations R-squared Number of births moved Panel B: Vaginal, induced Baby Bonus Observations R-squared Number of births moved Panel C: Cesarean section, not induced Baby Bonus Observations R-squared Number of births moved Panel D: Cesarean section, induced Baby Bonus Observations R-squared Number of births moved 24.429 [14.651] 14 0.67 86 (2) 14 days 16.429 [9.088] 28 0.38 115 (3) 21 days 12.647 [6.963] 42 0.32 133 (4)
28 days 13.661 [5.679] 56 0.28 191
66.143 [11.587] 14 0.94 232
39.714 [8.553] 28 0.86 278
33.186 [6.363] 42 0.87 348
25.250 [5.311] 56 0.87 354
86.429 [19.798] 14 0.9 303
51.214 [13.489] 28 0.8 358
37.412 [10.089] 42 0.82 393
32.448 [7.856] 56 0.83 454
12.143 [3.700] 14 0.85 43
7.643 [2.547] 28 0.76 54
4.304 [2.184] 42 0.72 45
3.089 [1.710] 56 0.73 43
Dependent Variable is the Number of Births by Various Procedures. Notes: Standard errors in brackets. signicant at 10%; signicant at 5%; signicant at 1%. All specications are based on data from 2004 only, and include day of week xed effects and an indicator for public holidays. Window denotes the number of days before and after the start of July. For example, the 7 day window covers the last seven days of June and the rst seven days of July. Number of births moved is W / 2, where W is the number of days in the window.
years, we use only data from 2004. Consequently, we can no longer include day-of-year and year xed effects, and our estimating equations are simply: Birthsi IiBaby Bonus IiDay of
IiPublic
lnBirthsi IiBaby Bonus IiDay of
Table 3 shows the results of our unlogged specications. For each specication, we show the coefcient on the Baby Bonus, and estimate the number of births shifted using the same methodology as in Panel A of Table 1. For all but one of the specications (non-induced vaginal births over a 7-day window), we observe a statistically signicant increase in births after the introduction of the Baby Bonus. In terms of numbers of births, the coefcients are largest for induced vaginal births and non-induced cesarean section births. In Table 4, we estimate the effect using logged births as the dependent variable. These results suggest that induced vaginal, induced cesarean section, and non-induced cesarean section procedures rose by a similar amount: 2331% within the 7 day window, and 811% within the 28 day window. Non-induced vaginal births rose by a smaller amount, and the effect is only statistically signicant in the 21 and 28 day windows. In Table 5, we estimate regressions that are analogous to those in Table 2, but separated by birth procedure. This allows us to observe more precisely the decrease and increase in births across June and July. This suggests that the drop in births in late-June was predominantly driven by a reduction in cesarean section and induction procedures, and the rise in early-July was driven mostly by cesarean section procedures, and to a lesser extent by non-induced vaginal births and induced vaginal births. In the bottom rows of Panel A, we calculate the total number of births moved from June to July by each procedure (this is done by summing the before coefcients or the after coefcients, and multiplying by seven in either case). These results suggest that the effect of the Baby Bonus was to reduce the number of vaginal induced births in June by 425, and the number of cesarean section, not induced births by 349; and to increase the numbers of non-induced vaginal births in July by 349, the number of induced vaginal births in July by 265, and the number of non-induced cesarean section births in July by 548. These results imply that the Baby Bonus caused not only a shift in timing, but also a shift between birth procedures. Approximately 200 babies who would have been induced in June were instead born vaginally without induction or by cesarean section in July.
Table 4 Baby Bonus effects for different birth procedures Window (1) 7 days Panel A: Vaginal, not induced Baby Bonus Observations R-squared Share of births moved Panel B: Vaginal, induced Baby Bonus Observations R-squared Share of births moved Panel C: Cesarean section, not induced Baby Bonus Observations R-squared Share of births moved Panel D: Cesarean section, induced Baby Bonus Observations R-squared Share of births moved 0.064 [0.040] 14 0.67 3% (2) 14 days 0.043 [0.025] 28 0.37 2% (3) 21 days 0.034 [0.020] 42 0.31 2% (4) 28 days 0.038 [0.016] 56 0.28 2%
0.547 [0.072] 14 0.97 31%
0.333 [0.068] 28 0.89 18%
0.279 [0.053] 42 0.89 15%
0.211 [0.044] 56 0.89 11%
0.448 [0.055] 14 0.98 25%
0.270 [0.058] 28 0.91 14%
0.206 [0.046] 42 0.91 11%
0.170 [0.038] 56 0.91 9%
0.421 [0.101] 14 0.94 23%
0.298 [0.091] 28 0.82 16%
0.200 [0.080] 42 0.78 10%
0.151 [0.062] 56 0.79 8%
Dependent Variable is the Log of the Number of Births by Various Procedures. Notes: Standard errors in brackets. signicant at 10%; signicant at 5%; signicant at 1%. All specications are based on data from 2004 only, and include day of week xed effects and an indicator for public holidays. Window denotes the number of days before and after the start of July. For example, the 7 day window covers the last seven days of June and the rst seven days of July. Share of births moved is exp(/2) 1.
Although these gures are estimated using only one year of AIHW data instead of 30 years of ABS data, and do not include day-ofweek and year xed effects, it is reassuring to see that the sum of the estimated effects is approximately similar to Table 2 (the sum is 899 for June, and 1172 for July). The results using a log specication (Panel B of Table 5) show the proportionate effects. In percentage terms, the largest drop in births in June occurred in vaginal induced births, while the largest rise in July occurred in cesarean sections. Overall, the above results indicate that virtually all the drop in births in June was due to a fall in cesarean section and induced births. Of the rise in births in July, about three-tenths were vaginal non-induced births, about two-tenths were vaginal induced births, and about half were cesarean sections. One corollary of the drop in induced births in late-June and the increase in cesarean sections in early-July is that the share of all births delivered by these measures rose with the introduction of the Baby Bonus. Fig. 5 plots the share of births in which labor was induced and/or a cesarean section procedure was performed (as noted above, these are not mutually exclusive categories in the data: 5% of births are induced but the baby is delivered by cesarean section). Across 2004, the share of induced/cesarean births was 48%. However, there are substantial differences before and after the Baby Bonus was introduced. In the last 28 days of June, the share of induced/cesarean births was 45%, while in the rst 28 days of July it was 49%. Starker still, the induced/cesarean share in the nal week of June was 42%, while in the rst week of July it was 52%. 5. Parental and child characteristics In this section, we consider the characteristics of children and their parents; comparing those who were born just before and after the introduction of the Baby Bonus. In particular, we focus on three factors: whether the births that were moved were to parents of higher or lower socioeconomic status (SES) than average, whether those babies who were moved weighed more or less than average, and whether the Baby Bonus had any impact on infant mortality.30 The relationship between parents' SES and whether they moved their child's birth date to qualify for the Baby Bonus depends upon two considerations. If moving a child's birth date involved some trade-off between risk and additional income, low-SES parents might be more likely to move their child's birth than high-SES parents. However, if parents with private health insurance were better able to affect the timing of their child's birth, then high-SES parents (who are more likely to have private health
30 We also tested additional hypotheses, including whether the Baby Bonus effect differed for teen mothers, unmarried mothers, Indigenous parents or multiple births (e.g. twins). We found no statistical association between these factors and whether a birth was moved into the eligibility period.
J.S. Gans, A. Leigh / Journal of Public Economics 93 (2009) 246263 Table 5 Baby Bonus effects for different birth procedures (1) Vaginal, not induced Panel A: Dependent variable is number of births Before June 39, 2004 10.821 [7.880] June 1016, 2004 0.736 [8.480] June 1723, 2004 5.464 [7.880] June 2430, 2004 0.321 [7.880] After July 17, 2004 24.750 [7.880] July 814, 2004 13.893 [7.880] July 1521, 2004 6.321 [7.880] July 2228, 2004 4.607 [7.880] Observations 112 R-squared 0.29 Total births moved from June 30 Total births moved to July 347 Panel B: Dependent variable is log births Before June 39, 2004 0.031 [0.023] June 1016, 2004 0.002 [0.024] June 1723, 2004 0.017 [0.023] June 2430, 2004 0.002 [0.023] After July 17, 2004 0.066 [0.023] July 814, 2004 0.039 [0.023] July 1521, 2004 0.019 [0.023] July 2228, 2004 0.014 [0.023] Observations 112 R-squared 0.29 (2) Vaginal, induced (3) Cesarean section, not induced (4)
Cesarean section, induced
1.179 [5.421] 7.706 [5.833] 8.893 [5.421] 43.036 [5.421] 23.107 [5.421] 4.393 [5.421] 9.107 [5.421] 1.25 [5.421] 112 0.93 425 265
7.893 [8.169] 2.721 [8.791] 9.893 [8.169] 29.321 [8.169] 57.107 [8.169] 6.107 [8.169] 3.964 [8.169] 11.107 [8.169] 112 0.91 349 548
1.554 [2.548] 2.19 [2.742] 0.696 [2.548] 9.125 [2.548] 3.018 [2.548] 2.446 [2.548] 4.982 [2.548] 2.125 [2.548] 112 0.75 95 12
0.009 [0.041] 0.086 [0.044] 0.067 [0.041] 0.379 [0.041] 0.167 [0.041] 0.051 [0.041] 0.062 [0.041] 0.007 [0.041] 112 0.95
0.02 [0.041] 0.037 [0.045] 0.044 [0.041] 0.152 [0.041] 0.296 [0.041] 0.048 [0.041] 0.028 [0.041] 0.048 [0.041] 112 0.95
0.029 [0.089] 0.128 [0.096] 0.033 [0.089] 0.320 [0.089] 0.101 [0.089] 0.141 [0.089] 0.134 [0.089] 0.023 [0.089] 112 0.81
Notes: Standard errors in brackets. signicant at 10%; signicant at 5%; signicant at 1%. All specications include day of year, public holiday, and year day of week xed effects. Sample covers May 6 to August 25 (56 days before and 56 days after July 1) for 2004 only. Total births moved is the sum of the coefcients (in the before or after period) multiplied by 7.
insurance) might be more likely to move their child's birth date than low-SES parents.31 Since we are unable to observe in the data whether a parent has private health insurance, the observed relationship between moving birthdates and parental SES will mask these competing predictions. The second outcome we consider is the birth weight of children born before and after the introduction of the Baby Bonus. We focus on three variables birth weight (in grams), the share of children who are low birth weight (less than 2500 g), and the share of children who are high birth weight (more than 4000 g). If the introduction effect caused parents to delay birth, then it should be the case that babies born after the Baby Bonus was introduced will weigh more than those born just before the introduction. The nal child-related outcome we consider is infant mortality. It is possible that the movement of births for non-medical reasons could lead to additional complications. Alternatively, it might be the case that the record number of deliveries during the weeks following the introduction of the Baby Bonus led to overcrowding in maternity wards, which increased the risk of death for newborns.
31 In 2004-05, 51% of Australians aged 15 and over had a private health insurance policy. From ages 25 to 54, holding private health insurance is positively correlated with age. Private health insurance is also positively correlated with income. Holding age constant, 23% of those in the lowest income quintile had private health insurance, as compared with 76% of those in the highest income quintile (ABS, 2006).
Fig. 5. Share of births delivered by induction and/or cesarean section. Data cover JuneJuly 2004. Panel A shows the unadjusted share, while Panel B shows the share relative to expected, accounting for day of week and public holidays.
To test these hypotheses, we (via the Australian Bureau of Statistics) wrote to all eight state and territory births and deaths registrars to request unit-record data on births and infant deaths. Three states and territories (Victoria, Western Australia, and the Australian Capital Territory) agreed to provide us with births data, while ve states and territories (New South Wales, Queensland, Western Australia, Tasmania and the Northern Territory) agreed to provide us with deaths data. Our births analysis is therefore based upon the three birth-reporting states, which accounted for 36% of Australian births in 2004. Analysis of the introduction effect for the birth-reporting states conrms that the impact of the Baby Bonus on births was very similar to the impact observed when using data for all of Australia. We conduct our infant mortality analysis in two ways. One approach is to calculate the daily infant mortality rate using data only from Western Australia (the sole state to provide us with both births and deaths data), while the other approach is to calculate infant mortality rates by combining deaths data from the ve death-reporting states with births data for all of Australia.32 While using just Western Australia has the advantage of precision, it provides us with only a small sample (10% of 2004 births were in Western Australia). Using the ve death-reporting states increases the sample size (67% of 2004 births were in these states), but requires that we assume that the pattern of births is the same in these states as it is in the rest of Australia. We regress parental SES and children's birth weight on dummies for the day of the week, public holidays and, of course, the Baby Bonus introduction. Standard errors are clustered by birth date. Where the dependent variable is linear, we use OLS, and where it is binary, we use a probit model. We run a similar regression on daily infant mortality (that is, deaths per 1000 births on a given day). Since our focus is on the effects of birth complications on infant mortality, infant deaths in our sample are restricted to those that occurred within one month of birth, and in which the death is classied as being caused by conditions originating in the perinatal period (specically, ICD-10 category P). Table 6 presents the results from the parental regressions. Parents whose children were born shortly after the introduction of the Baby Bonus appear to be slightly older than parents of those born just prior to the introduction, though the coefcients are small and mostly statistically insignicant. We observe no systematic income differences. Of course, this could be the result of the offsetting theoretical predictions discussed earlier. For example, having private health insurance (more common among older and
In 2004, these ve states accounted for 67% of the births in Australia, so we scale down the denominator by a factor of 0.67.
J.S. Gans, A. Leigh / Journal of Public Economics 93 (2009) 246263 Table 6 Parental characteristics Window (1) 7 days Panel A: Dependent Variable is Mother's Age Baby Bonus 0.180 [0.125] Observations 3287 R-squared 0.01 Panel B: Dependent Variable is Father's Age Baby Bonus 0.201 [0.114] Observations 3233 R-squared 0.01 Panel C: Dependent Variable is Average of Mother's Age and Father's Age Baby Bonus 0.181 [0.097] Observations 3287 R-squared 0.01 Panel D: Dependent Variable is Log Mean Income in Mother's Zipcode Baby Bonus 0.001 [0.007] Observations 2206 R-squared 0.01 (2) 14 days 0.074 [0.123] 6718 0.01 (3) 21 days 0.106 [0.103] 10120 0.01 (4)
28 days 0.118 [0.095] 13459 0.01
0.022 [0.125] 6604 0.01
0.113 [0.111] 9938 0.01
0.086 [0.091] 13225 0.01
0.046 [0.116] 6718 0.01
0.100 [0.099] 10120 0.01
0.102 [0.087] 13459 0.01
0.002 [0.004] 4527 0.01
0.001 [0.004] 6800 0.01
0.004 [0.004] 9045 0.01
Notes: Standard, clustered at the birth date level, errors in brackets. signicant at 10%; signicant at 5%; signicant at 1%. All specications are estimated using OLS, based on data from 2004 only, and include day of week and public holiday xed effects. Window denotes the number of days before and after the start of July. For example, the 7 day window covers the last seven days of June and the rst seven days of July. Panel A to C regressions use data from the Australian Capital Territory, Victoria, and Western Australia. Average parental age is the mother's age if the father is not present at the birth. Log mean income in mother's zipcode is matched on from the 2001 Census (mother's zipcode is unavailable in the Victorian births le, so Panel D uses data from the Australian Capital Territory and Western Australia).
richer parents) may have mattered at least as much as simple income effects (which one would expect to be larger among younger and poorer parents). Table 7 presents results for child outcomes. On average, children born in the week after the introduction of the Baby Bonus weighed 75 g more than children born in the week prior to its introduction (Panel A), and were 3% more likely to be of high birth weight (Panel C). The impact of the Baby Bonus on birth weight appears to be conned to the rst 12 weeks, with results for the 21 day and 28 day windows being insignicant. Conrming this pattern, Fig. 6 plots the share of high birth weight babies born in June and July 2004, indicating a spike immediately after the introduction of the Baby Bonus. (A regression of the high birth weight share on day of week and public holiday dummies reveals no signicant relationship, so we show only the raw data.) Across 2004, 11.5% of babies in our sample were of high birth weight. During the nal week of June, the high birth weight share was 10.6%. In the rst week of July, it was 13.8%. The increased share of high birth weight babies that accompanied the introduction of the Baby Bonus might potentially have led to adverse health consequences. While babies born pre-term and/or underweight are less likely to be healthy, the same is also true of babies born too late and/or overweight.33 Evidence on this point comes from Thorngren-Jerneck and Herbst (2001), who analyzed data from over 1 million births in Sweden in the 1980s and 1990s. As their outcome measure, they used the child's Apgar score (a ve-item measure of skin color, heart rate, reex irritability, muscle tone, and respiration, which ranges from 0 to 10). Apgar scores below 7 are regarded as being low, and Thorngren-Jerneck and Herbst plotted the relationship between low Apgar scores and birthweight, and between low Apgar scores and gestation length. Fig. 7 (taken from Thorngren-Jerneck and Herbst, 2001) demonstrates a clear U-shaped relationship for both variables. This suggests that exogenous increases in gestational age or birth weight may potentially have adverse health consequences. Nonetheless, while the evidence on birth weight suggests that the introduction of the Baby Bonus had both real (as opposed to reported) timing consequences and might have put some children at risk, we do not nd strong evidence that this had more dire consequences. Panels D and E of Table 7 focus on infant mortality. In both the Western Australian sample and the ve deathreporting states sample, we nd no statistically signicant relationship between the introduction of the Baby Bonus and the infant
33 Guidelines dened by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists dene pre-term births as those that occur up to the end of the 37th week of pregnancy, term births as those that occur from the 38th to the 42nd week, and post-term births as those that occur on or after the rst day of the 43rd week of pregnancy (AAP, ACOG, 2002; see also WHO, 1992, Engle, 2006).
260 Table 7 Child Outcomes Window (1)
(2) 14 days 17.602 [26.226] 2102 0.01
(3) 21 days 1.621 [21.124] 3174 0.01
(4) 28 days 6.933 [18.999] 4218 0.01
7 days Panel A: Dependent Variable is Birth Weight (in grams) Baby Bonus 75.170 [25.204] Observations 1040 R-squared 0.01 Panel B: Dependent Variable is an Indicator for Low Birth Weight (b 2500 g) Baby Bonus 0.005 [0.012] Observations 1040 Pseudo R-squared 0.01 Panel C: Dependent Variable is an Indicator for High Birth Weight (N 4000 g) Baby Bonus 0.029 [0.011] Observations 1040 Pseudo R-squared 0.01
0.005 [0.012] 2102 0.01
0.001 [0.009] 3174 0.01
0.001 [0.008] 4218 0.01
0.021 [0.010] 2102 0.01
0.009 [0.010] 3174 0.01
0.01 [0.008] 4218 0.01
Panel D: Dependent Variable is the Infant Mortality Rate (per 1000 live births) for Western Australia Baby Bonus 2.976 0.367 [2.976] [2.436] Observations 14 28 R-squared 0.54 0.19 Panel E: Dependent Variable is the Infant Mortality Rate (per 1000 live births) for 5 Death-Reporting States Baby Bonus 0.692 0.825 [0.935] [0.792] Observations 14 28 R-squared 0.76 0.24
0.943 [2.110] 42 0.14
0.674 [1.579] 56 0.1
0.421 [0.643] 42 0.17
0.465 [0.527] 56 0.21
Notes: Standard errors, clustered at the birth date level, in brackets. signicant at 10%; signicant at 5%; signicant at 1%. All specications are based on data from 2004 only, and include day of week and public holiday xed effects. Panels B and C show marginal effects from a probit model; the other results are OLS coefcients. Window denotes the number of days before and after the start of July. For example, the 7 day window covers the last seven days of June and the rst seven days of July. Regressions in Panels A to C use data from the Australian Capital Territory, Victoria, and Western Australia. Regressions in Panel D use data from Western Australia only. Regressions in Panel E use data from New South Wales, Queensland, Western Australia, Tasmania and the Northern Territory (with the denominator being 67% of the total number of births in Australia on each particular day).
mortality rate. Of the eight coefcients, four are positive and four are negative. While it is possible that more complete data might show an effect, we cannot conclude on the data available to us that the introduction of the Baby Bonus increased infant mortality. 6. Coda: the 2006 increase in the Baby Bonus In 2004, at the time of announcing the Baby Bonus, the Australian government promised that it would be increased in the future. These increases would take two forms: an indexed increase every March and September, and a large increase to $4000 on July 1, 2006. Consequently, expectant parents in mid-2006 were faced with similar incentives to those in mid-2004. A child born on June 30, 2006 received a Baby Bonus payment of $3166 (the value of the Baby Bonus after indexation), while a child born on July 1, 2006 received a Baby Bonus of $4000.34 While this increment was not as signicant as the initial introduction of the bonus, it still represented a non-trivial amount of money; equivalent to three-quarters of a week's post-tax income for the median household.35 In Fig. 8, we plot daily births for JuneJuly 2006, around the point at which the Baby Bonus increased. Again, we observe a fall in births in late-June, and a rise in early-July.36 In Table 8, we re-estimate Eqs. (2) and (3) using data from 19752003 and 200506.37 Our results show a substantial Baby Bonus effect around July 1, 2006. The coefcient on the 28-day window is 49, which suggests that 687 births were moved from June 2006 to July 2006, or about 4% the children who would otherwise have been born in June. Of these, about two-thirds were moved
34 A rst draft of this paper was released on June 18, 2006, and received considerable coverage in the Australian media. At that time, we unsuccessfully urged the government to phase in the 2006 increase. There is a slim chance that the publicity accorded to our study caused more births to be moved in 2006 (by drawing more attention to the sudden increase). 35 Unlike the 2004 change, this increment did not replace a previous and less transparent policy. Thus, the marginal nancial impact is more straightforward to estimate. 36 As a falsication exercise, we also looked at the pattern of births around July 1, 2005 (when there was no change in the Baby Bonus), and found no signicant changes. 37 We obtain very similar results if we also include data for 2004, and estimate the model with indicators for both the 2004 introduction and the 2006 increase.
Fig. 6. Proportion of births that are high birth weight. Solid horizontal lines show weekly means. Note: based on 2004 births data from the Australian Capital Territory, and Western Australia. High birth weight share does not vary systematically across the day of the week.
from the last week of June 2006 to the rst week of July 2006. The narrowness of this window suggests that it is unlikely that our results are driven by the timing of conceptions. However, unlike our 2004 results, we cannot entirely rule out the possibility of a conception effect in 2006.38 This second Australian experiment allows us to draw some more general conclusions about the responsiveness of birth timing to nancial incentives. Table 9 presents results from the 2004 and 2006 Baby Bonus changes, plus those of Dickert-Conlin and Chandra (1999) for the United States. Focusing only on the week before and after the change, the three studies together show that benets worth 15% of annual income caused 916% of births to be moved. However, Table 9 does suggest that the share of births moved is slightly larger as a result of the US tax benets of having a child (including the Child Tax Credit) than the Australian Baby Bonus. Several factors might account for this difference: one is that the foreseeability of the end of the US nancial year has a small effect on conceptions as well as births.39 The second possibility is that it is easier to hasten a birth (the incentive created by the US policy) than to delay it (the incentive created by the Australian rule). Finally, there is a different mix of private and public healthcare. As noted earlier, in Australia, high socioeconomic status was correlated with more delay. One reason for this may be that higher socioeconomic status was associated with parents having private health coverage (a situation closer to that in the US). 7. Conclusion and future directions In May 2004, the Australian government announced that it would provide a $3000 Baby Bonus to children born on or after July 1, 2004. This delay between the announcement and the introduction of the policy led to what we term an introduction effect. We estimate that over 1000 births were moved into the eligibility period, constituting 6% of the babies who would have been born in the month before the policy change. About three-quarters of the reduction in births in June occurred in the last week, and about three-quarters of the rise in births in July occurred in the rst week. But around one-quarter of the births that were moved appear to have been moved by more than one week. Analysis of birth procedures indicates that virtually all the drop in births in June was due to a fall in cesarean section and induction procedures. Of the rise in births in July, half were cesarean sections, three-tenths were vaginal non-induced births, and two-tenths were vaginal induced births. Consequently, the share of births delivered by cesarean section or induction rose substantially in July 2004. Analysis of a subsample of unit record birth data indicates that those babies born in early-July were signicantly more likely to be of high birth weight than babies born in late-June. Both these ndings indicate that the shift in birth timing observed in the aggregate data is a real phenomenon, and not merely due to the misreporting of birth dates. Two years later, a further increase in the Baby Bonus, implemented suddenly on July 1, 2006, had a similar effect on births; causing over 600 births (or 4% of those who would have been born in June 2006) to be moved to July 2006. This allows us to compare two Australian natural experiments with one another, and with evidence from sudden end-of-year changes in the US tax benets associated with having a child.
We also tested for changes in births around the smaller increments in the Baby Bonus (on March 20 and September 20), but found no consistent pattern. As all public nance economists know, the best way to maximize one's US child tax benet is to conceive by the end of March.
Fig. 7. Child health, birth weight and gestational age. Chart shows the odds ratio (OR) for an Apgar score below 7, plotted against birth weight (left panel) and gestational age (right panel). Source: Thorngren-Jerneck and Herbst (2001).
There are two important implications of the analysis here. First, these results suggest that when policymakers are announcing a new policy, they should think not only about the behavioral distortions of the policy over the long-run, but also of the possibility that the introduction of the policy may itself cause distortions in the short-run. Such effects are likely to be largest when a sharp policy discontinuity is announced in advance. The event studied here provides a clean example of the potential magnitudes involved. Second, we have identied a very signicant disruption to normal operating procedures for maternity hospitals and staff in Australia. This disruption appeared to impact both planned and unplanned birth procedures. Although we do not nd evidence of a rise in infant mortality, the overall health effects of this are not known. However, with more data, this event provides an opportunity for health researchers and economists to study the impact of a large disruption in a well-developed, modern medical
Fig. 8. The introduction effect in 2006. Panel A shows daily birth counts. Panel B shows births relative to expected, accounting for year, day of week, day of year, and public holidays. In panel B, shading shows days of unusually low births in June and unusually high births in July.
J.S. Gans, A. Leigh / Journal of Public Economics 93 (2009) 246263 Table 8 Birth Rate effects for the 2006 Increase Window (1) 7 days Panel A: Dependent variable is number of births Baby Bonus 2006 123.729 [14.693] Observations 434 R-squared 0.97 Number of births moved 433 Panel B: Dependent variable is ln(number of births) Baby Bonus 2006 0.176 [0.022] Observations 434 R-squared 0.97 Share of births moved 9% (2) 14 days 87.988 [10.841] 868 0.95 616 (3) 21 days 66.426 [9.131] 1302 0.94 697 (4)
28 days 49.055 [8.125] 1736 0.94 687
0.123 [0.016] 868 0.96 6%
0.095 [0.014] 1302 0.95 5%
0.072 [0.012] 1736 0.94 4%
Notes: Standard errors in brackets. signicant at 10%; signicant at 5%; signicant at 1%. Sample is daily births within the relevant window from 19752003 and 200506. All specications include day of year, public holiday, and year day of week xed effects. Window denotes the number of days before and after the start of July. For example, the 7 day window covers the last seven days of June and the rst seven days of July. Number of births moved is W / 2, where W is the number of days in the window. Share of births moved is exp( / 2) 1.
Table 9 Birth timing and nancial incentives Policy 2004 Baby Bonus introduction 2006 Baby Bonus increase US tax changes from 19791993 Incentive Delay Delay Hasten Could policy also affect conceptions? No Yes Yes Value (dollars) A$3000 (ignoring previous policy) A$834 US$401 (mean credit, 1996 dollars) Value (% of median annual household disposable income) 5.4% 1.4% 1.1% Share of births moved 16.2% 9.2% 13.6%
Notes: US estimates from Dickert-Conlin and Chandra (1999), Table 5. For all studies, effect sizes are based on a 7 day window, to allow comparability with Dickert-Conlin and Chandra (1999). Effect sizes for the 2004 and 2006 Baby Bonus changes are from Tables 1 and 8. Median household annual disposable income is from the Household, Income and Labour Dynamics in Australia survey (HILDA), and detailed income tabulations from the US Current Population Survey (available at www.census.gov).
system. The results of such studies have the potential to inform debates regarding the efcacy of planned birthdays and issues of under-stafng in hospitals. References
AAP, ACOG, 2002. Standard terminology for reporting of reproductive health statistics in the United States. Guidelines for Perinatal Care (5th edition, Appendix E). American Academy of Pediatrics and American College of Obstetricians and Gynecologists, Elk Grove, IL, pp. 377394. Anderson, L., 2004. An hour's difference between haves and have-nots. The Advertiser 2, 2 July. Arndt, B., 2004. A social cost in incentives to breed. Sydney Morning Herald May 21. Australian Bureau of Statistics, 2006. Private Health Insurance: A Snapshot, 200405. Cat No 4815.0. ABS, Canberra, ACT. Australian Taxation Ofce (ATO), 2004. Annual Report 200304. ATO, Canberra, ACT. Available at http://www.ato.gov.au/content/downloads/AR03-04_Book.pdf. Australian Treasury, 2004. 200405 Budget Paper No. 2. Australian Treasury, Canberra, ACT. Chandra, A., Baker, L., Dickert-Conlin, S., Goodman, D.C., 2004. Holidays and the Timing of Births in the United States, mimeo, MIT. Dickert-Conlin, S., Chandra, A., 1999. Taxes and the Timing of Births. Journal of Political Economy 107 (1), 161177. Eliason, M., Ohlsson, H., 2008. Living to save taxes. Economics Letters 100 (3), 340343. Engle, W.A., 2006. A recommendation for the denition of late preterm (near-term) and the birth weightgestational age classication system. Seminars in Perinatology 30 (1), 27. Finkelstein, A., 2007. E-ZTax: tax salience and tax rates. NBER Working Paper No. 12924. NBER, Cambridge, MA. Gans, J.S., Leigh, A., 2006a. Did the death of Australian inheritance taxes affect deaths? The B.E. Journal of Economic Analysis & Policy 6 (1) (Topics), Article 23. Gans, J.S., Leigh, A., 2006b. Bargaining over Labor: Do Patients Have any Power? mimeo, Melbourne. Gans, J.S., Leigh, A., 2007. What Explains the Fall in Weekend Births? mimeo, Melbourne. Gans, J.S., Leigh, A., In press. The Millennium Bub. Applied Economics Letters. Gans, J.S., Leigh, A., Varganova, E., 2007. Minding the shop: the case of obstetrics conferences. Social Science and Medicine 65 (7), 14581465. Grattan, M., Nguyen, K., 2004. Baby Bonus tempts teens, claims labor. The Age May 27. Kopczuk, W., Slemrod, J., 2003. Dying to save taxes: evidence from estate-tax returns on the death elasticity. Review of Economics and Statistics 85 (2), 256265. Leigh, A., Wolfers, J., 2002. Hardly family friendly. The West Australian 30 June. Lo, J.C., 2003. Patient attitudes vs. physicians determination: implications for cesarean sections. Social Science and Medicine 57, 9196. Massoud, J., 2004. Baby Bonus boom begins. Daily Telegraph 2 1 July. McDonald, P., 2005. Has the Australian fertility rate stopped falling? People and Place 13 (3), 15. Milligan, K., 2005. Subsidizing the Stork: new evidence on tax incentives and fertility. Review of Economics and Statistics 87 (3), 539555. Scott, L., 2004. Conned to sitting pretty quiet in the hope of bonus. The Australian 4 29 June. Thorngren-Jerneck, K., Herbst, A., 2001. Low 5-minute Apgar Score: a population-based register study of 1 million term births. Obstetrics and Gynecology 98 (1), 6570. Wells, R., 2004. Women decide: give birth today or take the $3000? The Age 9 30 June. World Health Organization (WHO), 1992. International Statistical Classication of Diseases and Related Health Problems (rev. 10, vols. 1 and 2; ICD-10). WHO, Geneva.
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