Evaluations of Public Health Policies on Disadvantaged Populations

This thesis is composed of two chapters in economics of healthcare. In these two chapters I use empirical econometrics methods to evaluate policy effects in two areas where disadvantaged populations exist as major stakeholders: formal long-term care and the opioid crisis in U.S. In the first chapter I study the relationship between nursing home's staff composition and the preference for patient types. Nursing homes rely on intensive nursing staff labor to provide long-term care services for the elder population across the U.S. However, the relationship between a nursing home’s permanent staff level and its preferred patient type remains under-studied. In this paper, I approach this question by leveraging state-level policy prohibiting the assignment of mandatory overtime shifts among nurses as an exogenous shock to nursing homes' ability to use flexible labor input. I find an approximately 10 percent reduction in total nursing hours provided by permanent nursing staff among nursing homes in treated states, suggesting an increase in the usage of contract nurses and nursing homes’ persistent need for labor flexibility. I also found a weak but statistically significant increase in the share of Medicaid patients at around 1.4 percent, consistent with my hypothesis that nursing homes switch to more predictable, longer-staying patients as the profit gap become narrowed by the increase in the cost of flexible labor input. My results highlight the impact of health providers’ staff choice set on the corresponding patient preferences. Policymakers should account for this linkage that could induce side effects for labor regulations on the health market. In the second chapter me and my coauthor Meiqing Ren study the unintended impact of supply-side policy interventions for opioid crisis in United States. Since early 2010, the fastly rising number of overdose deaths from illicit drugs including heroin and fentanyl has raised wide debate on effectiveness of contemporary supply-side policy interventions restricting access to prescription opioids. Meanwhile, the mechanism connecting reduced prescription opioids in the legal sector and increased usage of illicit drugs on black market remains unclear. We document the increase in street market purchases as a potential transitional phase to illicit drugs. Leveraging hydrocodone component products (HCPs) rescheduling in 2014 as a quasi-experimental negative shock to prescriptions supply, we find substantial increase in HCPs purchase on the street market following the policy. We find weak impacts on total drug overdose deaths and pain management quality following the policy, suggesting that intended welfare gain may be offsetted by damage to marginal populations heavily dependent on HCPs. Policy makers should note the limited effectiveness of similar supply-side interventions in absence of complementing efforts to reduce patients' demand.