Who’s Declining the “Free Lunch”? New Evidence from the Uptake of Public Child Dental Benefits
Ha Trong Nguyen, Huong Thu Le, and Luke B. Connelly.
This paper provides the first evidence on the determinants of uptake of two recent public dental benefit programs for Australian children and adolescents from disadvantaged families. Using longitudinal data from a nationally representative survey linked to administrative data with accurate information on eligibility and uptake, we find that only a third of all eligible families actually claim their benefits. These actual uptake rates are about half of the targeted access rates that were announced for them.
We provide new and robust evidence consistent with the idea advanced by recent economic literature that cognitive biases and behavioural factors are barriers to uptake. For instance, mothers with worse mental health or riskier lifestyles are much less likely to claim the available benefits for their children. These barriers to uptake are particularly large in magnitude: together they reduce the uptake rate by up to 10 percentage points (or 36%). Consistent with the evidence of behavioural barriers to uptake, the results also demonstrate that while prior preventive oral health behaviours affect the subsequent uptake, the child’s previous dental health conditions do not. Furthermore, we find some indicative evidence that a lack of information may be an important barrier to uptake: children living in owned homes are significantly more likely to take up the benefits than those in rented homes. The results also suggest that there may be a welfare stigma obstacle to uptake of the two child dental benefit programs because eligible children from families with higher income or private health insurance take up less. However, other characteristics of the child or the mother and the supply-side of the dental services market do not explain these differences.
Our findings of factors shaping the uptake decision have some potentially important policy implications. For example, to the extent that policymakers view raising uptake as a policy objective, the results provide insight into which groups policies that aim to help disadvantaged children should target. While some of barriers identified in this paper, including cognitive biases and behavioural barriers, may not be easily overcome, several studies have shown it may be feasible to address them. For instance, the role of limited cognitive ability in non-uptake can be mitigated by reminders about eligibility or simplification, e.g., through a visually more appealing notice. Reducing such barriers to uptake among disadvantaged groups may also help to lessen the documented intergenerational transmission of disadvantages. Overall, the results thus produce insights into the operation of the programs that are relevant not only to the success of the current program, but also for policy initiatives to improve their uptake in a range of population sub-groups.
December 6, 2019