Essays in the Economics of Healthcare and Health Insurance.

摘要

This dissertation contributes in two distinct ways to our understanding of the economics of healthcare and health insurance. Chapter 2 studies the decision process by which physicians allocate medical treatments to heart attack patients. The approach provides insight into the sources of well documented, but unexplained, disparities across demographic dimensions in health care utilization rates and health outcomes. In the model medical providers know how treatment alternatives affect patient-specific probabilities of three final health outcomes - death, readmission, and survival without readmission - and assign implicit values to each outcome that vary by patient age. The model does well in explaining the joint variation in treatments and outcomes, especially when including unobserved patient heterogeneity. Using decomposition methods, I show that a substantial fraction of gender differences in the use of intensive treatment is explained by a combination of the differences in the relative efficacy of treatment options for female patients, and the smaller implicit weight given to final outcomes of older patients. Chapter 3 explores how reforms to cash-assistance welfare programs in the United States in the mid 1990s acted as a structural shift in the health insurance and employment environment of lower income single mothers and find there may have been unintended consequences for this population's access to health insurance. With a more structured approach than is common in the literature, I estimate short and long run employment and insurance dynamics before and after the reforms. I show that reform reduced use of cash-assistance and increased the probability of employment, but created a less stable employment and health insurance environment. After the reform low income single mothers were less likely to retain the same employment and insurance status over a four month period. Although policy did not target Medicaid eligibility, individuals were less likely to retain Medicaid enrollment over the short and longer run after reform.