Essays on Long-Term Care and Aging.

This dissertation contains three empirical papers on important health policy issues. The first paper looks at the effect of changes in levels of Medicare home health care services on the informal care use of disabled, older adults. I estimate two-part models of informal care use, where the key independent variable is a measure of Medicare home health payment restrictiveness. Individuals who lived in states with less Medicare home health care services increased their use of informal care, although this effect is only observed among low-income individuals. The second paper assesses the effects of changes in employment incentives on the supply of informal support from adult children to their disabled, older parents. This study focuses on one specific form of informal support, co-residence with a disabled parent. I compare changes in co-residence patterns between 1990 and 2000 across groups of middle aged women whose co-residence patterns were arguably comparable, and who experienced very different changes in employment incentives. Results from difference-in-difference models provide support to the hypothesis that increasing employment incentives reduces the supply of informal support to disabled parents. The third paper looks at the effect of education on health status. This paper builds on the extensive research literature on this topic by measuring health in terms of the number of Quality-Adjusted Life Years experienced by individuals over an extended period of time. This measure captures overall health status over time, which is arguably a more important measure than point-in-time measures of specific health conditions or longevity alone. I use changes in compulsory schooling laws to identify the causal effect of education on health. Instrumental variables models provide evidence that the health returns to education are both statistically significant and substantial.Ph.D.Health Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/61743/1/egolber_1.pd

Social Contagion Of Mental Health: Evidence From College Roommates

From a policy standpoint, the spread of health conditions in social networks is important to quantify, because it implies externalities and possible market failures in the consumption of health interventions. Recent studies conclude that happiness and depression may be highly contagious across social ties. The results may be biased, however, because of selection and common shocks. We provide unbiased estimates by using exogenous variation from college roommate assignments. Our findings are consistent with no significant overall contagion of mental health and no more than small contagion effects for specific mental health measures, with no evidence for happiness contagion and modest evidence for anxiety and depression contagion. The weakness of the contagion effects cannot be explained by avoidance of roommates with poor mental health or by generally low social contact among roommates. We also find that similarity of baseline mental health predicts the closeness of roommate relationships, which highlights the potential for selection biases in studies of peer effects that do not have a clearly exogenous source of variation. Overall, our results suggest that mental health contagion is lower, or at least more context specific, than implied by the recent studies in the medical literature. Copyright © 2012 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99092/1/hec2873.pd

The Effect of School Quality on Black-White Health Differences: Evidence from Segregated Southern Schools

This paper assesses the effect of black-white differences in school quality on black-white differences in health in later life due to the racial convergence in school quality for cohorts born between 1910 and 1950 in southern states with segregated schools. Using data from the 1984 through 2007 National Health Interview Surveys linked to race-specific data on school quality, we find that reductions in the black-white gap in the pupil-teacher ratio and term length led to reductions in the black-white gap in self-rated health, disability, and body mass index.

Healthcare Marketplace Disruptions

Our health care coverage, access to medical providers, and prices of care regularly change. Sometimes the changes are unwelcome – such as when a favorite doctor is no longer covered by an insurance network. Change can also be good, however, when it delivers higher quality care at a lower price. Health care innovations may bring welcome changes, but their full impacts are not understood. Harvard Business School Professor Ariel Stern will discuss the risks and potential of innovation in the medical device and pharmaceutical industries. University of Minnesota Professor Ezra Golberstein will moderate.Center for the Study of Politics and Governance; Blue Cross Blue Shield of Minnesot