Three essays in health economics : determinants of individual health, medical care use, and treatment

by Lori L. Timmins

Institution: University of British Columbia
Department: Economics
Degree: PhD
Year: 2015
Record ID: 2061356
Full text PDF: http://hdl.handle.net/2429/51975


This dissertation studies and identifies determinants of individual health. The first chapter analyzes how the supply of medical care affects patient treatment and health outcomes, focusing on how hospitals respond to the loss of a profitable service line. This chapter provides strong evidence that hospital spillovers across service lines are empirically important and that hospitals differentiate treatment by patient payer type. Hospitals practice both revenue augmenting and cost-cutting behavior in other lines of care, targeting specific procedures and payers according to their profitability. Specifically, they increase the number of surgical procedures and perform more marginal surgeries. The effects are concentrated in medical specialties where there are more discretionary surgeries and higher profit margins. Furthermore, hospitals cut back on unprofitable treatment by reducing non-elective admissions and uninsured elective care. Hospitals also increase the intensity of treatment among private payers. The second chapter of this dissertation investigates the demand side of health care, analyzing the role that health insurance plays on primary medical care usage by young American adults. I find office-based physician visits and prescription drugs are not affected by insurance, but dental visits are. There is a small increase in out-of-pocket expenditures caused by insurance loss, concentrated heavily at the top of the distribution. No change in health status or ability to afford care is found. The findings shed light on the expected welfare benefits of recent US health care policies targeting young adults. The final chapter of this dissertation analyzes the extent to which the early childhood environment shapes child health and development outcomes and, specifically, whether universal childcare levels the playing field across children. I analyze the introduction of a universal childcare program in Quebec in 1997, testing its impact on the distribution of child health and development outcomes. I find that there is little heterogeneity in the response to the policy across the distributions of child motor skills and cognitive outcomes. I do, however, find evidence that it led to a reduction in child body weight at the upper end of the distribution.