Three Essays on Health and Labor Economics

In Chapter 1, I explore how the way policies are implemented influence how consumer's respond to them. The Supplemental Nutrition Assistance Program (SNAP) provides food assistance to nearly 44 million Americans each year. I document a substantial increase in the program’s ability to stimulate food consumption from 1990 to 2010, as measured by the marginal propensity to consume food (MPCf) out of SNAP. I provide the first evidence for a mechanism driving this increase: the transition from paper coupons to Electronic Benefit Transfer (EBT) cards. Using plausibly exogenous variation over states and time I estimate that the introduction of EBT doubles the MPCf out of SNAP and accounts for 25 percent of its observed increase. In Chapter 2, I examine the effects of occupational licensing regulations on patient choice, costs, and outcomes in maternal care. In the United States, there are substantial restrictions on who can provide healthcare and how they do so. These labor market restrictions seek to improve quality, but may also increase the cost to provide services and limit consumer choice. I examine this tradeoff by using plausibly exogenous variation in the strictness of Scope-of-Practice laws for Certified Nurse Midwives (CNMs). Half of all states have relaxed their SOP laws to allow CNMs to practice and prescribe independently of a physician. I estimate the effect of granting CNMs full independence on hospital facility costs using administrative data from the Centers for Medicare and Medicaid Services (CMS) and inpatient discharge records from the Healthcare Cost and Utilization Project (HCUP). Using a difference-in-differences research design, I find that allowing CNMs to practice independently substantially reduces hospital facility costs per birth and the use of intensive procedures, such as cesarean sections. These cost reductions are concentrated in hospitals that are well-positioned to integrate CNMs into their practice. I find that maternal health outcomes, as measured by the rate of Severe Maternal Morbidity, also improve. Using a structural choice model, I decompose the overall effect of the policy into savings generated from increased hospital efficiency and savings due to changing selection of patients into hospitals. I find that the savings are primarily driven by increased hospital efficiency for low-risk patients and higher-risk patients select into higher-cost hospitals after the law change. These effects are attenuated by market concentration and a high density of OBGYNs. Finally, in Chapter 3 I investigate the extent to which hospitals are able to pass on cost increases (or decreases) to consumers via changes in prices. This marginal cost pass-through rate is a key parameter in estimating the incidence of policy changes on patients and hospitals. I create an instrument for marginal cost by combining plausibly exogenous variation in the price of a key input, electricity, with differential exposure to this variation due to capital decisions made in the past. I find that hospitals completely pass on changes in marginal costs to patients via changes in prices. I find no evidence that hospitals adjust their volume, patient mix, or mix of inputs in the short-run.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Graduate College

Grantor dc:publisher

The University of Arizona.

Year dc:date.issued

2021

Author dc:creator

• Eck, Chase

Advisor dc:contributor.advisor

• Langer, Ashley

Committee members dc:contributor.committeemember

• Gowrisankaran, Gautam
• Joiner, Keith
• Pantano, Juan

• Certified Nurse Midwives
• EBT
• Hospital Price
• Marginal Cost Pass-through
• Scope of Practice
• SNAP

Statement dc:rights

• Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.

Licence dc:rights.uri

• http://rightsstatements.org/vocab/InC/1.0/

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/10150/660176

OAI identifier oai:identifier

oai:repository.arizona.edu:10150/660176