Three Essays on Health Economics

This dissertation studies how local economic conditions and design of program features affect provider decisions and the wellbeing of Medicaid beneficiaries. Using microdata on Medicaid claims, I obtain estimates of the association between weak labor market conditions and the quantity of office-based services received by children enrolled in Medicaid in the first paper. I find that children receive more services in areas with higher unemployment. The effect could reflect either demand factors such as worsening health or supply factors such as changes in the number of physicians willing to accept Medicaid patients. Using variation in the local unemployment rate induced by the Great Recession, I provide several pieces of evidence against demand-side explanations. Instead, the finding is consistent with a supply-side mechanism: higher unemployment reduces the demand for physician services by privately-insured patients. Physicians respond to demand shock by treating more Medicaid enrollees. In the second paper, I study the effect of the Medicaid expansions that occurred under the Patient Protection and Affordable Care Act (ACA) on mortality. The ACA enabled states to expand Medicaid eligibility to all low-income non-elderly adults. As a result, a significant proportion of previously uninsured people gained health insurance coverage. I calculate the fraction of people eligible for the Medicaid program for demographic groups based on their pre-ACA household income. Using variation over time in eligibility rules by state/county and by parental status, I estimate the impact of Medicaid eligibility on age-specific mortality rates. I find that the expansion of Medicaid eligibility reduced healthcare amenable mortality rates by about 1.8% for adults aged 55-64. There are no detectable mortality impacts for the younger adult population. In the third paper, I study the question of whether Medicaid reimbursement for obstetric care affects treatment decisions. I use claim data that can differentiate payments for bundled service and individual delivery service. While I do not find a relationship between Medicaid payment and C-section rate, I find that within-state changes in Medicaid reimbursements for delivery leads to changes in the choice of billing code. Delivery fees also affect the amount of prenatal care, suggesting the change in billing practice may reflect actual modifications in the delivery of maternity care.