Essays in Health Economics

Abstract

This dissertation consists of three essays, each examining a topic in health economics. These papers are connected by the theme of exploring the ways in which institutions, such as hospitals and pharmaceutical companies, interact with federal and state policies and what that ultimately means for healthcare consumers. In Chapter 1, I estimate the effect of prescription drug coupons on generic drug use, medication adherence, and competition between branded drugs. I take advantage of a law in Massachusetts banning, and then allowing, prescription drug coupons to estimate a series of difference-in-differences and triple-difference regressions. I find that prescription drug coupons decrease own-molecule generic drug use, and that this effect is driven by patients requesting the brand name drug. I find no effect of coupons on medication adherence, competition between branded drugs, or cross-molecule generic substitution. These results are consistent with prescription drug coupons increasing costs without improving health. In Chapter 2, I estimate the effect of for-profit hospital ownership on the probability of admission through the emergency department (ED). I use variation from hospital conversions to estimate difference-in-differences and event study regressions. I find that for-profit hospital ownership increases the probability of inpatient admission, with the effect driven by Medicare and Medicaid patients. However, I also find evidence that increased admission rates occur when hospitals convert from for-profit as well as to for-profit, indicating that the estimated effect may actually be measuring the effect of hospital system membership and not ownership. In Chapter 3, I estimate the effect of policies that decrease the time cost to patients of accessing long-acting reversible contraceptives (LARCs) on LARC uptake, birth rates, and birth outcomes. I take advantage of Medicaid policies which were implemented by states at different times to estimate difference-in-differences and event study regressions. I find no evidence that Medicaid coverage for immediate postpartum LARCs affected LARC use or birth outcomes, though our estimates are imprecise.