Taking Cover - Human Capital Accumulation in the Presence of Shocks and Health Insurance - Article

Jul 19, 2026

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Using a large-scale health-insurance expansion in Mexico alongside local rainfall variation, this study examines whether program-driven healthcare coverage shields primary school children’s cognitive outcomes when adverse rainfall shocks occur. Findings show that universal healthcare reduces the detrimental impact of atypical rainfall on test performance, especially for marginalized and rural communities. Mechanism evidence indicates fewer sickness episodes, reduced time lost, and greater stability in household consumption for eligible families exposed to shocks.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Abstract

Introduction

Research question and contribution

Health insurance reform context (Seguro Popular)

Data and identification strategy

Results and mechanisms

Pub lic Disclosure Authorized Pub lic Disclosure Authorized The World Bank Economic Review, 37(3), 2023, 437–459 [https://doi.org10.1093/wber/lhad008](https://doi.org10.1093/wber/lhad008) Article Taking Cover: Human Capital Accumulation in the Presence of Shocks and Health Insurance Paulino Font-Gilabert Abstract Using the expansion of a large-scale health-insurance program in Mexico and variation in local rainfall levels, this study explores whether the program-induced increase in healthcare coverage protected the cognitive attainment of primary school children in the event of adverse rainfall shocks. Results show that the universalization of healthcare mitigated the negative effect of atypical rainfall on test scores, particularly in more marginalized and rural areas. An analysis of the mechanisms at play shows a reduced incidence of sickness among children, lower demand for their time, and higher stability in household consumption among program-eligible families exposed to rainfall shocks. JEL classification: I13, I15, I25, O12 Keywords: universal healthcare, resilience to shocks, cognitive attainment, Seguro Popular 1. Introduction Universal health coverage has recently evidenced its potential to protect the world’s population against global health shocks (Aarabi, Haghighi, and Takian 2020) . While the WHO pushes for its expansion as a major goal for health reform to address inequalities in health and financial outcomes (WHO and World Bank 2017, 2020), little is known about the protective effect that social health insurance can have in other domains. This study seeks to investigate whether access to public health insurance protects children’s performance in school during adversity. The study therefore contributes to a growing area of research evaluating the extent to which different public programs can mitigate the negative effect of weather and other environmental shocks on human capital formation. For instance, conditional cash transfers ease the negative effect of rainfall shocks on educational attainment in Mexico (Adhvaryu et al. 2018) and Colombia (Duque, Rosales-Rueda, and Sanchez Torres 2019), a rural employment scheme in India mitigates the Paulino Font-Gilabert is a research affiliate at King’s College London, 16 De Crespigny Park, London SE5 8AF, UK; his email address [is paulino.font_gilabert@kcl.ac.uk. For helpful](is paulino.font_gilabert@kcl.ac.uk. For helpful) comments and discussions, the author thanks Sonia Bhalotra, seminar participants at ISER, the ICID-SITES-IFAD conference in Rome, the Public Health and Development Workshop atthe University of Gothenburg, the EUDN PhD workshop on Development Economics at CERDI, the ESPE 2019 Annual Conference, the Young Economists’Meeting at Masaryk University, and the EEA-ESEM 2019 Congress. The author also thanks three anonymous referees for providing valuable feedback, and gratefully acknowledges funding from the Economic and Social Research Council – Research Centre on Micro-Social Change. A supplementary online appendix is available with this article at The World Bank Economic Review website. The author declares that he has no relevant or material financial interests that relate to the research described in this paper. © The Author(s) 2023 . Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development / THE WORLD BANK. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Downloaded from [https://academic.oup.com/wber/article/37/3/437/7068455 by World Bank and IMF user on](https://academic.oup.com/wber/article/37/3/437/7068455 by World Bank and IMF user on) 14 September 2023 impact of heat waves on children’s cognition

FAQs

How does universal health coverage affect children’s cognitive test performance under rainfall shocks?

Universal healthcare mitigates the negative effect of atypical rainfall on test scores. The reduction is strongest in more marginalized and rural areas.

What mechanisms explain why the health insurance program provides protection?

The study finds lower incidence of sickness among children, reduced demand on their time, and greater stability of household consumption for eligible families facing rainfall shocks.

What data and measurements are combined to estimate the effects?

The study uses yearly standardized primary school tests, the insurance-driven increase in health coverage from the reform, and rainfall precipitation measured at the school-locality level in an area affected by ENSO.

Jul 19, 2026

Upload by Liam