ESSAYS ON HEALTH AND FAMILY ECONOMICS

This thesis includes a collection of three distinct essays that study empirically the determinants of health and human capital and build a foundation for policy interventions. Chapter 2 investigates the relationship between giving birth through unplanned caesarean section and mothers' mental health after childbirth. Previous studies have mostly explored the impact of this procedure on hospital expenditure and newborns, ignoring its effect on the new mothers' health. This chapter extends the literature by showing that having an unplanned caesarean section increases the risk of postnatal depression. The effect is even larger when accounting for the endogeneity of delivery method. Chapter 3 uses a sample including all patients who received a coronary bypass during the period 2000-2010 within the English National Health Service to shed light on the effect of long waiting times for elective surgeries on patients' health. Waiting times have been extensively used as a non-price rationing mechanism in countries with universal health care systems. However, it is unclear whether rationing by waiting harms individuals' health. We find no evidence of waiting times increasing the risk of in-hospital mortality and an adverse but weak effect on 28-day emergency readmission following discharge. With Chapter 4, the focus is shifted from healthcare systems to families, looking at the determinants of parental investments in children. We explore how parents' time investment, namely the amount of time they spend in formative activities with their children, responds to variations in their offspring's health, cognitive and socio-emotional abilities. Results indicate that mothers react differently to changes in different dimensions of the child's human capital; more specifically, they compensate for reductions in children's socio-emotional abilities. We also observe heterogeneous behaviours, which depend on mothers' level of education and working status

Social restrictions, leisure and well-being

A wide-ranging public debate surrounds how pandemic lockdown measures differentially impacted individuals and which precise mechanisms – whether financial-, health-, or policy-driven – predominate in determining these effects. Using a nationally representative 24-h diary survey covering the first two years of the pandemic, we explore potential mechanisms underlying changes in well-being. We exploit the variation in the stringency of the social restrictions implemented by the UK government during this period and use an event-study methodology to net out the impact of social restrictions from other pandemic effects. We find that well-being dropped by 47 % (for men) and 71 % (for women) of a standard deviation during the strictest lockdown and that it took longer to revert to pre-pandemic levels than previously estimated. This finding holds after we account for financial conditions and changes in local infection and death rates, suggesting that the time use–related changes driven by social restrictions dominate financial and health shocks in driving the overall well-being effects during the pandemic. Our detailed data on time allocation and individual preferences over the activities undertaken throughout the day suggest that the drop in well-being was primarily associated to a drastic reduction in time spent in leisure with non–household members or outside the home, a category with greater weight in the well-being of women

Gender stereotypes in the family

We study whether and why parents have gender-stereotyped beliefs when they assess their child’s skills. Exploiting systematic differences in parental beliefs about a child’s skills and blindly graded standardized test scores, we find that parents overestimate boys’ skills more so than girls’ in mathematics (a male-stereotyped subject), whereas there are no gender differences for reading. Consistent with an information friction hypothesis, we find that the parental gender bias disappears for parents who are interviewed after receiving information on their child’s test scores. We further show that the parental gender bias in detriment of girls contributes to explain the widening of the gender gap in mathematical skills later in childhood, supporting the hypothesis that exposure to gender biases negatively influence girls’ ability to achieve their full potential

Do parental time investments react to changes in child's skills and health?

Parental time investment decisions have been found to have important effects on child development; however, little is known about the response of parents to changes in their child's human capital across time. Using the Longitudinal Study of Australian Children, we measure time investments considering the time young children spend, with or without parents, in different activities. By adopting a child fixed-effect instrumental variable estimation, we find that parents reinforce for high socio-emotional skills by spending more time socialising with their child and compensate for low cognitive skills by increasing the time the child spends in learning activities

Do Waiting Times Affect Health Outcomes? : Evidence from Coronary Bypass

Long waiting times for non-emergency services are a feature of several publicly-funded health systems. A key policy concern is that long waiting times may worsen health outcomes: when patients receive treatment, their health condition may have deteriorated and health gains reduced. This study investigates whether patients in need of coronary bypass with longer waiting times are associated with poorer health outcomes in the English National Health Service over 2000e2010. Exploiting information from the Hospital Episode Statistics (HES), we measure health outcomes with in-hospital mortality and 28-day emergency readmission following discharge. Our results, obtained combining hospital fixed effects and instrumental variable methods, find no evidence of waiting times being associated with higher in-hospital mortality and weak association between waiting times and emergency readmission following a surgery. The results inform the debate on the relative merits of different types of rationing in healthcare systems. They are to some extent supportive of waiting times as an acceptable rationing mechanism, although further research is required to explore whether long waiting times affect other aspects of individuals’ life

Mother’s health after baby’s birth: does delivery method matter? : Does the delivery method matter?

The dramatic increase in the utilization of caesarean section has raised concerns on its impact on public expenditure and health. While the financial costs associated with this surgical procedure are well recognized, less is known on the intangible health costs borne by mothers and their families. We contribute to the debate by investigating the effect of unplanned caesarean deliveries on mothers’ mental health in the first nine months after the delivery. Differently from previous studies, we account for the unobserved heterogeneity due to the fact that mothers who give birth through an unplanned caesarean delivery may be different than mothers who give birth with a natural delivery. Identification is achieved exploiting exogenous variation in the position of the baby in the womb at the time of delivery while controlling for hospital unobserved factors. We find that mothers having an unplanned caesarean section are at higher risk of developing postnatal depression and this result is robust to alternative specifications

Social Restrictions and Well-Being: Disentangling the Mechanisms

Using a nationally representative 24-hour diary survey covering the first two years of the pandemic, we explore the mechanisms underlying the changes in wellbeing for men and women. We exploit the variation in the stringency of social restrictions implemented by the UK government during this period and use an event-study methodology to net out the impact of social restrictions from other pandemic effects. We find that well-being dropped by 47% (men) and 70% (women) of a standard deviation during the strictest lockdown, and this effect survives after accounting for financial conditions and changes in local infection and death rates. Our data on time allocation and individual preferences over the activities undertaken throughout the day reveal that the drop in well-being is primarily driven by a drastic reduction in time spent in leisure with non-household members or outside the home

Social restrictions, leisure and well-being

A wide-ranging public debate surrounds how pandemic lockdown measures differentially impacted individuals and which precise mechanisms – whether financial-, health-, or policy-driven – predominate in determining these effects. Using a nationally representative 24-hour diary survey covering the first two years of the pandemic, we explore potential mechanisms underlying changes in well-being. We exploit the variation in the stringency of the social restrictions implemented by the UK government during this period and use an event-study methodology to net out the impact of social restrictions from other pandemic effects. We find that well-being dropped by 47% (for men) and 71% (for women) of a standard deviation during the strictest lockdown and that it took longer to revert to pre-pandemic levels than previously estimated. This finding holds after we account for financial conditions and changes in local infection and death rates, suggesting that the time use–related changes driven by social restrictions dominate financial and health shocks in driving the overall well-being effects during the pandemic. Our detailed data on time allocation and individual preferences over the activities undertaken throughout the day suggest that the drop in well-being was primarily associated to a drastic reduction in time spent in leisure with non–household members or outside the home, a category with greater weight in the well-being of women