Three Essays on Health Economics and Policy Evaluation

Abstract

Three Essays on Health Economics and Policy Evaluation Shishir Shakya This dissertation consists of three essays on U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-indifference, double selection post-LASSO, and spatial difference-indifference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances (must-access PDMPs), vary from the counties where such a PDMP check is voluntary. I find must-access PDMP reduces about seven retail opioid prescriptions dispensed per 100 persons per year in each county. But, when I compare must-access PDMPs counties with bordering counties without such law, I find a reduction of three retail opioid prescriptions dispensed per 100 persons per year suggesting the possibility of spillovers of retail opioid prescribing behaviors. As of 2019, all U.S. states, except Missouri, have enacted voluntary Prescription Drug Monitoring Programs (PDMPs). In response to the relatively low uptake of voluntary access, several states have strengthened their PDPMs by requiring providers to access information regarding prescription drug use under certain circumstances. These "must-access" PDPMs require states to view a patient's prescription history to facilitate the detection of suspicious prescription and utilization behaviors. This paper develops causal evidence of the effectiveness of "must-access" PDPM laws in reducing prescription opioid overdose death rates relative to voluntary PDMP states. I find that PDMPs are ineffective in reducing prescription opioid overdose deaths overall, but the effects are heterogeneous across states with "must-access" PDMP states. I find that marijuana and naloxone access laws, poverty level, income, and education confound the impact of must-access PDMPs on prescription opioid overdose deaths. The optional provision of Medicaid expansion, through the Affordable Care Act (ACA), has triggered a national debate among diverse stakeholders regarding the impacts of Medicaid coverage on various dimensions of public health, costs, and benefits. Randomized experiments like the Rand Health Insurance Experiment and the Oregon Health Insurance Experiment have generated some credible estimates of the average treatment effects of insurance access. However, identical policy interventions can have heterogeneous effects on different subpopulations. This paper uses data from the Oregon Health Insurance Experiment to estimate the heterogeneous treatment effects of access to Medicaid on health care utilization, preventive care utilization, financial strain, and self-reported physical and...