Three essays in health economics

Overview

Abstract (English)

This thesis comprises three essays that empirically investigate important issues in two areas of health economics: physician labour supply and health insurance policy interventions. In the first essay, gendered associations between family status and physician labour supply are explored in the Canadian labour market, where physicians are paid according to a common fee schedule and have substantial discretion in setting their hours of work. Data from 1991 to 2006 show no gender difference in physician labour supply after controlling for family status. Male and female physicians have statistically indistinguishable hours of work when never married and without children. Married male physicians, however, have higher market hours than unmarried male physicians and parenthood either increases their hours or leaves them unchanged. In contrast, married female physicians have lower market hours than unmarried physicians and parenthood substantially lowers market hours. Little change over time in these patterns is observed for males, but for females two offsetting trends are observed: the magnitude of the marriage-hours effect declined, whereas that for motherhood increased. Preferences and/or social norms induce substantially different labour market outcome across the sexes. In terms of work at home, the presence of children is associated with higher hours for male physicians, but for females the hours increase is at least twice as large. A male physician’s spouse is much less likely to be employed in the presence of children, and if employed, has lower market hours in the presence of children. In contrast, a female physician’s spouse is more likely to be employed in the presence of children, and if employed, has slightly lower market hours in the presence of children. Both male and female physicians have lower hours of work when married to another physician. This second essay examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public healthcare system with free physician and hospital services. Beginning in 1997, all residents of the province of Quebec, Canada, were required by law to have drug insurance coverage. Under this program, all persons under age 65 who are eligible for a private plan are required to join that plan, while the public prescription drug insurance plan covers all Quebecers who are not eligible for a private plan. Using the National Population Health Survey from 1994 to 2003, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization. findings from quantile regressions suggest that there was a large improvement in the health status of less healthy individuals. Further analysis by pre-policy drug insurance status and the presence of chronic conditions reveals a marked increase in the probability of taking medication and visiting a general practitioner among the previously uninsured and those with a chronic condition. We also find evidence of positive health gains among the chronically ill. The third essay examines the impact of delisting routine eye exam services on patient eye care utilization and on providers’ labour market outcomes in a public healthcare system. Beginning in the early 1990s, provincial governments in Canada started to de-insure routine eye examinations from the basket of publicly funded health care services. We exploit delisting policy changes across Canadian provinces to estimate the impact of delisting from the supply- and demand-sides. Demand side analysis using the National Population Health Survey and Canadian Community Health Survey data suggests that the delisting of eye exams for the working age population decreased the probability of using eye care among this population group. However, the number of visits among those who continued to use eye care services was not affected. We also find suggestive evidence that the delisting policies targeted at the working age population were associated with increased eye care utilization among the elderly patients. Using the optometrist sample from the Canadian census data we find that the delisting of eye exams decreased optometrists’ weekly work hours while raised their annual work weeks. There was no statistically significant effect on optometrists’ income.

Abstract (French)

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