The impact of firm, individual, and government choice on health outcomes

This dissertation is comprised of three essays that consider how choices made by firms, individuals, and governments have impacts on health outcomes. In the first essay, a legislative policy shock is used to determine why nursing home facilities converted to a new ownership type and how these conversions subsequently lead to changes in the quality of care provided between 1999 and 2004. As a result of a legislative change in reimbursement policy, nearly five percent of nursing homes converted. Conversions from a not-for-profit to for-profit was found to be associated with a decrease in the use of physical restraints while the proportion of residents with pressure ulcers in facilities that converted from for-profit to not-for-profit increased. The second essay analyzes how promotion of sickness insurance by the government contributed to the reduction in the infant mortality rate in six European countries between the Franco-Prussian War and the Great War. The results suggest that for every additional percentage point of the adult population that is covered by sickness insurance infant death rates declined by additional 0.39 to 1.11 deaths per 1000 live births in this period. The final essay studies how individual choice to purchase insurance affects out-of-pocket expenditures on antidepressant medications by elderly Medicare recipients. This essay discusses the econometric problems faced in the estimation of medical expenditures and finds that the average out-of-pocket expenditure on antidepressants decreases with supplemental insurance.Ph.D.Includes bibliographical references (p. 81-89)