Essays in health economics

One of the main goals of public health insurance expansions is to increase access to health care services, but doing so may require providers to move to previously underserved areas. Whether and to what extent any such relocation occurs remains an open question. In the first essay, I study how providers choose their practice locations in response to Medicaid expansions for one of the most common forms of primary care, dental care services. I find that expansions of adult Medicaid dental benefits increased the number of dentists per capita in poor counties relative to non-poor counties by 12 percent, or 2.6 dentists per 100,000 population. The increase was larger in counties where the expansions generated greater financial incentives for dentists. In the second essay, we investigate the implementation of Medicare Part D and estimate that this prescription drug benefit program reduced elderly mortality by 2.2 percent annually. This was driven primarily by a reduction in cardiovascular mortality, the leading cause of death for the elderly. There was no effect on deaths due to cancer, a condition whose drug treatments are covered under Medicare Part B. We validate these results by demonstrating that the changes in drug utilization following the implementation of Medicare Part D match the mortality patterns we observe. We calculate that the value of the mortality reduction is equal to 5 billion per year. In the third essay, we evaluate the effect of teenage driving laws on mortality using the minimum driving age in a regression discontinuity design. We estimate that gaining driving eligibility leads to an immediate increase in teenage mortality of 15 percent (8 per 100,000). Many states have recently implemented Graduate Driving License (GDL) (4 per 100,000). We calculate that the social benefit of this mortality reduction is equal to $1.5 billion annually