Essays on health economics

Chapter 1: Medicare provides nearly-universal health insurance for individuals aged 65 and older. The discontinuity in eligibility for Medicare provides an instrument for assessing the effects of insurance coverage on health outcomes. Using regression discontinuity analysis and data from the BRFSS, this paper finds an increase in utilization of preventive health services, as well as an improvement in self-reported health, at age 65. The effects vary across education level and gender. However, these results would be biased by high retirement rates at age 65. To address this issue, I run similar analysis at age 62, when individuals are first eligible to collect Social Security. I find that utilization is positively correlated with insurance but not retirement. The implications of these findings for assessing the cost-effectiveness of preventive care are limited, because the cross-sectional data do not capture the long-term benefits of diagnostic procedures. Chapter 2: This paper assesses the effects of working on the health of less-educated women, particularly mothers. These effects are difficult to estimate because health status affects labor force participation. To address this endogeneity problem, I use an instrumental variables estimation approach. Throughout the 1990s, changes in the EITC and the transition from AFDC to TANF provided exogenous incentives for women to enter the work force, independent of their own health status. This paper builds on the literature by including the incentives created by welfare reform and EITC which vary by state. It also includes measures of both physical and mental self-reported health, giving a broad picture of the effects of entering the labor force on the health of this population. Chapter 3: This chapter (with Atsuko Tanaka), examines the effect of depression on various labor force outcomes, including hours worked and wages. We use panel data from the Japanese Panel Survey of Consumers (JPSC) and the Health and Retirement Study (HRS) to follow respondents over several years, using questions about both mental health and labor force outcomes. In order to understand the causal effect of depression on work participation and compensation, we use deaths of the parents of respondents as an exogenous shock to mental health.

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Mental health

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