Addressing Barriers to Human Capital Accumulation: Essays in Development and Health Economics

Addressing Barriers to Human Capital Accumulation: Essays in Development and Health Economics
Author: Sophie Ochmann
Publisher:
Total Pages: 0
Release: 2023
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ISBN:

While health and education, jointly referred to as human capital, are important ends in themselves, they are also important drivers of poverty alleviation and economic growth. Understanding and overcoming the barriers that constrain human capital accumulation is hence crucial for economic development. This dissertation examines three barriers to human capital accumulation in three essays. Essay one studies whether providing school-based management committees with a grant and training can improve primary educational attainment in Sokoto, Nigeria. We thereby contribute evidence from an unders...

Three Essays in Health Economics

Three Essays in Health Economics
Author:
Publisher:
Total Pages: 157
Release: 2014
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The intersection of health, inequality, and human capital is the source of some of the large and complex problems that continue to challenge our health care system and our health policy decision makers. My study touches on two areas at this nexus: socioeconomic determinants of health/development and economic costs (e.g., human capital, labor market) of chronic illness and disability. The first chapter examines the labor market outcomes of women co-residing with a disabled parent or parent-in-law. Because the vast majority of women providing this form of eldercare are still in their working years, informal care responsibilities may involve considerable opportunity costs. Using the Panel Study of Income Dynamics, I construct a longitudinal dataset documenting the labor market and co-residential eldercare experiences of sample women over 25 years. On average, I find that women co-residing with a disabled elder are less likely to engage in labor market work. However, responses vary over the life course. Co-residence prior to age 40 is associated with a 9 percentage point reduction in the likelihood of employment, an effect size twice that found for women over 50. The second chapter examines how poverty may affect brain structure and development. Little is known about how poverty is translated into deficits in cognition and achievement. Using a sample of children and adolescents (4 to 22 years) from the NIH Pediatric MRI Data Repository, we consider a potential neurobiological channel. We find that children from poor households display a maturational lag. Moreover, this atypical development is reflected in standardized assessments of academic ability and achievement. The third chapter examines the influence of sibling chronic illness or disability on children's early educational outcomes. Using a sample of sibling pairs from the PSID Child Development Supplement, we consider several categories of common childhood disabilities to explore whether and to what extent sibling health spillovers may vary according to the domain or severity of sibling impairment. We find evidence of substantial and heterogeneous effects of poor childhood health on well-sibling outcomes. Estimated spillovers in the case of developmental disabilities, in particular, are large and robust across a series of sensitivity analyses.

Three Essays on Health Economics

Three Essays on Health Economics
Author: Keisha T. Solomon
Publisher:
Total Pages: 138
Release: 2019
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My dissertation covers three loosely related topics in health and education economics that focus on examining factors that may affect children's and young adults' health capital and human capital accumulation. The first essay examines the effect of state-level full parity mental illness law implementation on mental illness among college-aged individuals and human capital accumulation in college. It is important to consider spill-overs to these educational outcomes, as previous research shows that mental illness impedes college performance. I utilize administrative data on completed suicides and grade point average, and survey data on reported mental illness days and decision to drop-out of college between 1998 and 2008 in differences-in-differences (DD) analysis to uncover causal effects of state-level parity laws. Following the passage of a state-level full parity law, I find that the suicide rate reduces, the propensity to report any poor mental health day reduces, college GPA increases, and the propensity to drop out of college does not change. The second essay investigates the effects of family size on child health. This essay is a joint study with Kabir Dasgupta. In this study, we use matched mother-child data from the National Longitudinal Surveys to study the effects of family size on child health. Focusing on excess body weight indicators as children's health outcome of interest, we examine the effects of exogenous variations in family size generated by twin births and parental preference for mixed sex composition of their children. We find no significant empirical support in favor of the quantity-quality trade-off theory in instrumental variable regression analysis. This result is further substantiated when we make use of the panel aspects of the data to study child health outcomes of arrival of younger siblings at later parities. The third essay estimates the causal effect of being born out of wedlock on a child's health outcome and early academic achievements. Specifically, the study uses rich panel data from the National Longitudinal Survey of Youth 1979 (NLSY79) and the Children of the NLSY79 (NLSY79-child), coupled with a sibling fixed-effects model to address omitted variable bias attributable to unobserved family characteristics. The study findings suggest that the results from the OLS models have been driven by unobserved family effects, because the significance of the results disappear for the sibling fixed-effects models. Also, due to the large confidence intervals, and the signs changing for some of the regression coefficients, I cannot conclusively state whether being born to a married mother has no significant impact on children's health and education.

Essays in Health Economics

Essays in Health Economics
Author: Yiwei Chen
Publisher:
Total Pages:
Release: 2019
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The dissertation is a collection of three essays written on policy issues related to U.S. and Chinese healthcare systems. The first chapter, titled "User-generated Physician Ratings—Evidence from Yelp, " analyzes the effect of user-generated physician ratings from online sources on the healthcare market. They become increasingly popular among consumers, but since consumers typically lack the ability to evaluate clinical quality, it is unclear whether these ratings actually help patients. Using the universe of Yelp physician ratings matched with Medicare claims, I examine what information on physician quality Yelp ratings reveal, whether they affect patients' choices of physician, and how they influence physician behavior. Through text and correlational analysis, I show that although Yelp reviews primarily describe physicians' interpersonal skills, Yelp ratings are also positively correlated with various measures of clinical quality. Instrumenting physicians' average ratings with reviewers' "harshness" in rating other businesses, I find that a one-star increase in physicians' average ratings increases their revenue and patient volume by 1-2%. Using a difference-in-differences strategy, I test whether, in response to being rated, physicians order more substances that are desirable by patients but potentially harmful clinically. I generally do not find that physicians substantially over-prescribe. Overall, Yelp ratings seem to benefit patients—they convey physicians' interpersonal skills and are positively correlated with their clinical abilities, and they steer patients to higher-rated physicians. In the second chapter, titled "Consolidation of Primary Care Physicians and Healthcare Utilization, " (coauthored with Liran Einav, Jonathan Levin, and Jay Bhattacharya from Stanford University) we use administrative data from Medicare to document the massive consolidation of primary care physicians over the last decade, and its impact on patient healthcare utilization. Since patients' decisions to visit large or small organizations are likely endogenous, we employ two research designs that attempt to address this selection and isolate the causal effect of the physician organization size on patient healthcare utilization. The first takes advantage of the heterogeneity in the extent of primary care consolidation across healthcare markets, and the second exploits transitions of physicians across organizations. Our preferred specification suggests that visiting large physician organizations leads to a 16% reduction in the patient's healthcare utilization, and that this reduction is primarily driven by fewer primary care visits and lower number of inpatient admissions. In the third chapter, titled "Effects of Primary Care Management in Rural China, " (coauthored with Hui Ding and Karen Eggleston from Stanford University, Min Yu, Jieming Zhong, Ruying Hu, Xiangyu Chen from Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China, and Chunmei Wang, Kaixu Xie from Tongxiang Center for Disease Control and Prevention, Tongxiang, China) we turn our attention to the Chinese healthcare system. Health systems globally face increasing morbidity and mortality from chronic diseases, yet many—especially in low- and middle-income countries—lack strong primary care. We analyze China's efforts to promote primary care management for insured rural population with chronic disease using unique panel data for over 70,000 Chinese in 2011-2015. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries—villages within two kilometers distance but managed by different townships, we find that villagers with hypertension/diabetes residing in a township with more intensive primary care management had more primary care visits, fewer specialist visits, fewer hospital admissions, and lower inpatient spending. No such effects are evident in a placebo treatment year. Exploring the mechanism, we find that patients with more intensive primary care management exhibited better drug adherence. A back-of-the-envelope estimate suggests that the resource savings from avoided inpatient admissions substantially outweigh the costs of the program.

Essays in the Economics of Child Health and Skill Formation

Essays in the Economics of Child Health and Skill Formation
Author: Giacomo Mason
Publisher:
Total Pages: 0
Release: 2019
Genre:
ISBN:

Recent research on human capital development during childhood has focused on three im- portant avenues, among others: measurement, modelling, and interventions. In this thesis, in touch on each of these in turn. The chapter titled "The effect of cash and information on child development" examines the child development effects of a "cash plus" intervention in Nigeria, which starts from the pregnancy period. It underlines the interplay between resources and information in achieving growth and cognition improvements. Chapter "Inequality in socioe- motional skills" highlights issues of measurement. It finds that there is no perfect invariance in the measurement of socioemotional skills in two cohorts of British five year olds born 30 years apart, and shows that socioeconomic determinants of such skills have changed over this period. Finally, the chapter titled "The role of diet quality and physical activity in the pro- duction of adolescent human capital" models the human capital production process in early adolescence, exploiting novel sources of exogenous variation to disentangle the health effects of diet and exercise. Significant complementarities between physical and mental health, and between mental health and diet, emerge from the analysis.