Author ORCID Identifier

https://orcid.org/0000-0001-9068-9056

Year of Publication

2022

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Business and Economics

Department/School/Program

Economics

First Advisor

Dr. Charles Courtemanche

Abstract

This dissertation consists of three chapters that study how public policies affect health-related outcomes in China. The first two papers examine the impacts of the country’s Critical Illness Insurance program on health-related outcomes. The third paper studies the effects of maternal education on children’s early childhood health outcomes and cognitive skills.

The first chapter evaluates the impact of a recent social health insurance benefits expansion program on middle-aged and elderly individuals. In 2012, China launched a Critical Illness Insurance (CII) program, which aimed to reduce out-of-pocket costs for individuals covered by the government’s health insurance programs. This chapter utilizes the staggered timing of CII adoption across cities to estimate the impact of CII on medical costs and health services for middle-aged and elderly individuals. For rural insured people, I find that CII had a negligible impact on the likelihood of using inpatient care but decreased out-of-pocket inpatient costs by 45% for those who did receive inpatient care. The reductions are largest for individuals over 60 years old, those who live in poor households, and enrollees with chronic illnesses. I do not find evidence of similar effects on urban insured residents’ inpatient and outpatient expenditures or utilization, which is expected since the urban insured are less affected by the CII program, given the higher pre-existing benefits in the urban insurance program.

The second chapter examines the impact of CII on health outcomes, health service utilization, and risky health behaviors. I explore the staggered timing of CII adoption across the cities and utilize generalized difference-in-differences and event-study models to provide the first estimates of CII’s health and behavioral impacts. Using a nationally representative longitudinal dataset, I show that CII has little effect on self-reported health, probability of getting diagnosed with any disease, inpatient care use, smoking and drinking behaviors, and BMI. These results suggest that the income effect from CII reducing out-of-pocket inpatient costs for middle-aged and elderly adults, as documented in the first chapter, has little improvement on health and no discernible impact on risky health behaviors.

The third chapter studies how maternal education affects children’s early childhood health outcomes and cognitive skills. I take advantage of the college expansion in China, which creates credible exogenous variation in access to colleges that improves educational attainment. Utilizing the difference in the number of colleges across provinces and cohorts, I employ an instrumental variable approach to examine how maternal education improves children’s outcomes. The results show that maternal education reduces the probability of infant low birth weight and improves children’s early cognitive skills development for mothers of rural origins. In contrast, little impact is found for mothers who grew up in urban areas. I investigate several mechanisms which could explain the outcomes and find that maternal education is strongly associated with assortative marriage and rural-urban migration.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2022.337

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