Dissertations, Theses, and Capstone Projects

Date of Degree

6-2024

Document Type

Dissertation

Degree Name

Ph.D.

Program

Economics

Advisor

Theodore J. Joyce

Committee Members

Michael Grossman

Henry Saffer

Subject Categories

Health Economics | Health Policy

Keywords

Health economics, Health policy, Natural experiment, Program evaluation, Health outcomes

Abstract

This dissertation consists of two chapters that investigate the effect of public health policies on health outcomes.

The first chapter evaluates the impact of the extensive health care reforms enacted between 2003–2013 under the Health Transformation Program (HTP) in Turkey on maternal and infant health outcomes for the poor. By focusing on a specific insurance program (Green Card) expansion that was a part of HTP, I explore changes in infant survival, fertility, and children’s vaccination status. Before 2004, all public health insurance beneficiaries (the control group) were covered for outpatient services, including prenatal and postnatal doctor visits, gestational diabetes screenings, lab studies, and medications, while Green Card holders (the treatment group) lacked this coverage. After the introduction of HTP, all households received coverage for these services. Using a difference-in-differences estimation methodology, I find that the policy shift led to (1) lower mortality rates by 35 deaths (or by 42%) per thousand survivors under age 5 born to mothers with Green Card, (2) a suggestive decline in the prevalence of low birth weight by 8 percentage points and (3) a higher preference for more children for women with Green Card. I find no effects of the policy shift on children’s immunization, however, I identify young mothers and mothers residing in eastern regions of the country as the sub-groups whose children had significantly lower vaccination rates.

The second chapter explores the effect of overdose prevention centers on overdose mortality in New York City. The surge in overdose deaths in the U.S. presents a pressing public health crisis. Despite a recent slowdown, overdose deaths remain significantly high, surpassing other leading causes of mortality. I employ a synthetic difference-in-differences strategy to assess the impact of two Overdose Prevention Centers (OPCs) in New York City on overdose mortality. I find a 14 percent increase in overdose mortality; although the point estimates are stable across specifications, they are not statistically significant. Event study estimates further reveal an increase in drug overdose mortality post-OPC opening, with a seemingly escalating impact over time. I also find that OPCs significantly increased entry into substance use disorder treatment by 19 percent, primarily driven by a higher rate of seeking rehabilitation among current drug users. These findings contribute to harm reduction policy discussions, informing policymakers grappling with effective strategies against drug abuse and overdose.

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