Using Standardised Patients to Assess the Quality of Medical Records: An Application and Evidence from Rural China
Impact of Second-Parent Migration on Student Academic Performance in Northwest China and its Implications
We find that rapid worker turnover significantly disrupts the productivity of responsive manufacturers. Our study uses a uniquely rich dataset drawn from China-based FATP (final assembly, testing, and packaging) facilities that produce millions of units of consumer electronic goods weekly yet exhibit high worker turnover exceeding 300% annually. The data cover the firm's weekly production plans, 52,214 workers' compensations and assignments, and assembly station productivity. To study managerial prescriptions, we extend the classical production planning problem to include endogenous worker turnover as an Experience-Based Equilibrium and use advances in reinforcement learning and approximate dynamic programming to estimate and simulate our model. Our empirical analyses exploit instrumental variables, including the firm's demand forecasts as demand shifters". We find that turnover's impact on yield waste is conservatively $146-178M, and that a well-calibrated wage increase reduces the manufacturer's variable production costs (including wages) by up to 21%, or $594M for the product we study. The wage increase reduces the firm's reliance on a larger workforce and overtime to hedge against yield disruptions from turnover; it stabilizes a leaner workforce and improves both production reliability and exibility. In settings where performance depends on workers repeating known tasks in coordinated groups, our results suggest that firms responsively matching supply to demand can pay a steep price for a disruptively turnover-prone workforce.
Heterogeneous Impacts of Basic Social Health Insurance on Medical Expenditure: Evidence from China's New Cooperative Medical Scheme
This paper examines the effects of China’s New Cooperative Medical Scheme (NCMS) on medical expenditure. Utilizing the quasi-random rollout of the NCMS for a difference-in-difference analysis, we find that the NCMS increased medical expenditure by 12.3%. Most significantly, the good-health group witnessed a 22.1% rise in medical expenditure, and the high-income group saw a rise of 20.6%. The effects, however, were not significant among the poor-health or low-income groups. The findings are suggestive of the need for more help for the very poor and less healthy.
Previous literature suggests subpar teaching is a primary reason why rural Chinese students lag behind academically. We initiate an investigation into the potential of educational technology (EdTech) to increase teaching quality in rural China. First, we discuss why conventional approaches of improving teaching in remote schools are infeasible in China’s context, referring to past research. We then explore the capacity of technology-assisted instruction to improve academic performance by examining previous empirical analyses. Third, we show that China is not limited by the resource constraints of other developing countries due to substantial policy support and a thriving EdTech industry. Finally, we identify potential implementation-related challenges based on the results of a preliminary qualitative survey of pilots of EdTech interventions. With this paper, we lay the foundation for a long-term research investigation into whether EdTech can narrow China’s education gap.
Using Community Health Workers to Deliver a Scalable Integrated Parenting Program in Rural China: A Cluster-Randomized Controlled Trial
Inadequate care during early childhood can lead to long-term deficits in skill development. Parenting programs are promising tools for improving parenting practices and opportunities for healthy development. We implemented a non-masked cluster-randomized controlled trial in rural China in order to assess the effectiveness of an integrated home-visitation program that includes both psychosocial stimulation and health promotion at fostering development and health outcomes of infants and toddlers in rural China. All 6-18 month-old children of two rural townships and their main caregiver were enrolled. Villages were stratified by township and randomly assigned to intervention or control. Specifically, in September 2015 we assigned 43 clusters to treatment (21 villages, 222 caregiver-child dyads) or control (22 villages, 227 caregiver-child dyads). In the intervention group, community health workers delivered education and training on how to provide young children with psychosocial stimulation and health care (henceforth psychosocial stimulation and health promotion) during bi-weekly home visits over the period of one year. The control group received no home visits. Primary outcomes include measures of child development (i.e. the Bayley Scales of Infant and Toddler Development, third edition—or Bayley-III) and health (i.e. measures of morbidity, nutrition, and growth). Secondary outcomes are measures of parenting practices. Intention-to-treat (ITT) effects show that the intervention led to an improvement of 0·24 standard deviations (SD) [95% CI 0·04 SD-0·44 SD] in cognitive development and to a reduction of 8·1 [95% CI 3·8–12·4] percentage points in the risk of diarrheal illness. In addition, we find positive effects on parenting practices mirroring these results. We conclude that an integrated psychosocial stimulation and health promotion program improves development and health outcomes of infants and toddlers (6–30 month-old children) in rural China. Because of low incremental costs of adding program components (that is, adding health promotion to psychosocial stimulation programs), integrated programs may be cost-effective.
Concurrent Validity of the Ages and Stages Questionnaire and the Bayley Scales of Infant Development III in China
Choosing a valid and feasible method to measure child developmental outcomes is key to addressing developmental delays, which have been shown to be associated with high levels of unemployment, participation in crime, and teen pregnancies. However, measuring early childhood development (ECD) with multi-dimensional diagnostic tests such as the Bayley Scales of Infant and Toddler Development III (Bayley-III) can be time-consuming and expensive; therefore, parental screening tools such as the Ages and Stages Questionnaire (ASQ-3) are frequently an alternative measure of early childhood development in largescale research. The ASQ is also becoming more frequently used as the first step to identify children at risk for developmental delays before conducting a diagnostic test to confirm. However, the effectiveness of the ASQ-3 is uncertain. In this study, we evaluate the accuracy of the ASQ-3 as a screening measure for children at risk of developmental delay in rural China by age group. To do so, we administered the Bayley-III, widely considered to be the “gold standard” of ECD diagnostic tests, to a sample of 1,831 five to twenty-four monthold children and also administered the ASQ-3 to their caregivers. We then compared the outcomes of the ASQ-3 test to those of the Bayley-III. We find that the ASQ-3 was significantly though weakly correlated with the Bayley-III and that the strength of this correlation increased with child age and was stronger when the mother was the primary caregiver (as compared to the grandmother). We also find that the sensitivity and specificity of ASQ-3 ranged widely. The overall findings suggest that the ASQ-3 may not be a very accurate screening tool for identifying developmentally delayed children, especially for children under 13 months of age or children whose primary caregiver is not the mother.
In China, low levels of early childhood development (ECD) in rural areas may inhibit economic development as the nation attempts to transition from a middle-income manufacturing-based economy to a high-income innovation economy. This paper surveys the recent literature on ECD among children ages 0-3 years in rural China, including rates of developmental delays, causes of delays, and implications for the future of China’s economy. Recent studies have found high rates of developmental delays among young children in rural China and point to poor nutrition and psychosocial stimulation as the primary causes. This review highlights the need for large-scale ECD interventions in rural China to raise human capital and support future economic growth.
Anemia is a serious nutritional deficiency among infants and toddlers in rural China. However, it is unclear how the anemia status changes among China’s rural children as they age. This study investigates the prevalence of anemia as children grow from infancy to preschool-age, as well as the dynamic anemia status of children over time. We conducted longitudinal surveys of 1170 children in the Qinba Mountain Area of China in 2013, 2015 and 2017. The results show that 51% of children were anemic in infancy (6–12 months), 24% in toddlerhood (22–30 months) and 19% at preschool-age (49–65 months). An even larger share of children (67%) suered from anemia at some point over the course of study. The data also show that although only 4% of children were persistently anemic from infancy to preschool-age, 8% of children saw their anemia status deteriorate. We further found that children may be at greater risk for developing anemia, or for having persistent anemia, during the period between toddlerhood and preschool-age. Combined with the finding that children with improving anemia status showed higher cognition than persistently anemic children, there is an urgent need for eective nutritional interventions to combat anemia as children grow, especially between toddlerhood and preschool age.
The Prevalence of Parent-Teacher Interaction in Developing Countries and its Effect on Student Outcomes
Empirical evidence from developed countries supports the idea that parent-teacher interaction is high and improves student outcomes. The evidence from developing countries is, however, decidedly mixed. Using longitudinal data from nearly 6000 students and their 600 teachers in rural China, we show the prevalence of parent-teacher interaction is generally much lower than that of developed countries. We also show parent-teacher interaction, when it exists, can have positive effects on raising academic achievement and reducing learning anxiety. We demonstrate that the prevalence and effectiveness of parent-teacher interaction in a developing country context varies considerably due to both demand-side and supply-side factors.
Stuck in Place? A Field Experiment on the Effects of Reputational Information on Student Evaluations
Studies suggest that students’ prior performance can shape subsequent teacher evaluations, but the magnitude of reputational effects and their implications for educational inequality remain unclear. Existing scholarship presents two major perspectives that exist in tension: do teachers primarily use reputational information as a temporary signal that is subsequently updated in response to actual student performance? Or do teachers primarily use reputational information as a filter that biases perception of subsequent evidence, thus crystallizing student reputations and keeping previously poor-performing students stuck in place? In a field experiment, we recruited a random sample of 832 junior high school teachers from the second-most populous province of China to grade a sequence of four essays written by the same student, and we randomly assign both the academic reputation of the student and the quality of the essays produced. We find that (1) reputational information influences how teachers grade, (2) teachers rely on negative information more heavily than positive information, and (3) negative reputations are crystallized by a single behavioral confirmation. These results suggest that students can escape their prior reputations, but to do so, they must contradict them immediately, with a single confirmation sufficient to crystallize a negative reputation.
Does Teacher Training Actually Work? Evidence from a Large-Scare Randomized Evaluation of a National Teacher Training Program
The Impact of Teacher Professional Development Programs on Student Achievement in Rural China: Evidence from Shaanxi Province
There is a significant gap in academic achievement between rural and urban students in China. Policymakers have sought to close this gap by improving the quality of teaching in rural areas through teacher professional development (PD) programs. However, there is limited evidence on the effectiveness of such programs. In this paper, we evaluate the impact of a PD program-National Teacher Training Program (NTTP) and find that the NTTP has no effect on math achievement. We also find that while the program has a positive effect on math teaching knowledge of teachers, it has no significant effect on teaching practices in the classroom. Taken together, these results indicate that teachers may have improved their knowledge for teaching from NTTP, but did not apply what they learned to improve teaching practices or student learning.
Abstract: We present results of a randomized trial testing alternative approaches of mapping student achievement into rewards for teachers. Teachers in 216 schools in western China were assigned to performance pay schemes where teacher performance was assessed by one of three different methods. We find that teachers offered “pay-for-percentile” incentives (Barlevy and Neal 2012) outperform teachers offered simpler schemes based on class average achievement or average gains over a school year. Moreover, pay-for-percentile incentives produced broad-based gains across students within classes. That teachers respond to relatively intricate features of incentive schemes highlights the importance of close attention to performance pay design.
Although students in rural and migrant schools in China generally have not performed well, a share of each cohort has been able to thrive in school and to test into academic high school and college. To understand the origins of persistence, specifically, why some students learn more than do others, researchers have identified certain sources of the problem. Few studies, however, have paid attention to the role that low levels of cognitive development of students play in their academic performance.
Impact of Various Types of Near Work and Time Spent Outdoors at Different Times of Day on Visual Acuity and Refractive Error Among Chinese School-Going Children
Old is Not Always Better: Evidence from Five Randomized Experiments in Rural Primary Schools in China
In recent years, researchers have begun to focus attention on trying to identify systematic factors that cause interventions to have different impacts in different contexts. In this paper, we seek to understand whether the age of principals at schools implementing nutrition-based interventions has an impact on program outcomes. To explore the relative effectiveness of younger and older school principals, we use data from five large-scale, nutrition-related randomized controlled trials (RCTs) involving 12,595 primary school students in 336 schools in rural China. Our results, using two age cut-offs for distinguishing young principals from old ones, indicate that improvements in the health and nutrition outcomes of students were significantly higher in schools with younger principals than in schools run by older principals (when using a cutoff of 40 years old). When using a cut-off of 45 years old, the point estimates of the impacts similarly suggest that young principals are more effective, although the results are not significantly significant. The results are similar when we look at the impact of disaggregated interventions in schools managed by young and old principals. The findings are clear that the interventions implemented by older principals are not more effective than those implemented by younger principals.
This paper describes the current level of human capital in China and seeks to identify a number of education-related challenges that may slow down the nation’s economy from transitioning to high-income status. Relying on recent census-based data from OECD for the rest of the world and using data from the 2015 Micro-Census for China, the authors show that the low levels of education of China’s labour force is really a problem that has its roots in the past (in the 1970s, 1980s, and 1990s). In recent years (since 2000), China has been investing heavily in education as shown by the increasing the share of youth, including rural youth, attending high school. Despite this recent effort to raise the nation’s human capital, the education system still faces several challenges in trying to provide high-quality education for all youth. First, the government must figure out a way to overcome the relatively low rates of participation in high school by rural students. Second, there is concern that many vocational schools, especially those in rural areas, cannot deliver quality education. Finally, the paper will show that many rural students may be unprepared due to poor early childhood development outcomes.
We assess and compare computer science skills among final-year computer science undergraduates (seniors) in four major economic and political powers that produce approximately half of the science, technology, engineering, and mathematics graduates in the world. We find that seniors in the United States substantially outperform seniors in China, India, and Russia by 0.76–0.88 SDs and score comparably with seniors in elite institutions in these countries. Seniors in elite institutions in the United States further outperform seniors in elite institutions in China, India, and Russia by ∼0.85 SDs. The skills advantage of the United States is not because it has a large proportion of high-scoring international students. Finally, males score consistently but only moderately higher (0.16–0.41 SDs) than females within all four countries.
Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning
Neurocysticercosis (NCC) significantly contributes to morbidity in developing countries. We recently published a study of prevalence and risk factors in school-aged children in three mountainous areas in Sichuan province of western China. Using structural equation modeling (SEM) on data from that study to guide intervention planning, here we examine risk factors grouped into three broad interventional categories: sociodemographics, human behavior, and sources of pork and pig husbandry. Because neuroimaging is not easily available, using SEM allows for the use of multiple observed variables (serological tests and symptoms) to represent probable NCC cases. Data collected from 2608 students was included in this analysis. Within this group, seroprevalence of cysticercosis IgG antibodies was 5.4%. SEM results showed that sociodemographic factors (b = 0.33, p < 0.05), sources of pork and pig husbandry (b = 0.26, p < 0.001), and behavioral factors (b = 0.33, p < 0.05) were all directly related to probable NCC in school-aged children. Sociodemographic factors affected probable NCC indirectly via sources of pork and pig husbandry factors (b = 0.07, p < 0.001) and behavioral variables (b = 0.07, p < 0.001). Both sociodemographic factors (b = 0.07, p < 0.05) and sources of pork and pig husbandry factors (b = 0.10, p < 0.01) affected probable NCC indirectly via behavioral variables. Because behavioral variables not only had a large direct effect but also served as a critical bridge to strengthen the effect of sociodemographics and sources of pork and pig husbandry on probable NCC, our findings suggest that interventions targeting behavioral factors may be the most effective in reducing disease.