Research

How do mass demand shocks affect access to healthcare services, and are wealthier regions better equipped to absorb these shocks? Mass migration represents a significant shock to public health goods provision, as increased demand from migrants can strain pre-existing healthcare capacity. To examine this, I study the Syrian refugee influx into Turkey following the 2011 civil war to estimate the causal impact on Turkish women’s access to reproductive healthcare. Using a distance-based instrument, I find that Turkish women in areas more exposed to refugees are more likely to receive prenatal and postnatal care, plausibly due to a shift toward private sector healthcare usage and crowding out of public services. The increase in private healthcare usage is concentrated among Turkish women in top wealth quintiles and more developed provinces, whereas the effects disappear in less developed regions. On the supply side, I observe a reallocation of healthcare professionals and hospital beds from the public to private sector—but only in developed provinces. These findings have important implications for the ideal allocation of refugees, how policymakers can optimize the distribution of public health services, and the crucial role the private sector can play in alleviating the burden on the public healthcare system.

The discussion on whether immigration solves the problems of population aging often focus on the fertility of immigrants. Additionally, standard projections consider the impact of migration on population growth but assume that the natives’ fertility does not change in response to migration. By contrast, we show that the native fertility is affected by immigration. In particular, we leverage the Syrian refugee migration to specific Turkish provinces shortly after the 2011 civil war as a source of variation in exposure to immigration. Employing two complementary instrumental variable strategies, we provide evidence that the fertility of natives increases in response to mass migration. These findings are robust across two distinct datasets, and we also observe a corresponding rise in subjective measures of fertility (that is, the ideal number of children). Furthermore, we conduct additional analyses to examine four potential mechanisms and to highlight heterogeneity in fertility responses among different population subgroups. Our results suggest that factors related to the labor market and norm transmission can plausibly explain the observed increase in native fertility.